McClung John Arthur
Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
Heart Fail Clin. 2017 Jul;13(3):633-644. doi: 10.1016/j.hfc.2017.02.014. Epub 2017 May 6.
Heart failure presents unique challenges to the clinician who desires to provide excellent and humane care near the end of life. Accurate prediction of mortality in the individual patient is complicated by a chronic disease that is punctuated by recurrent acute episodes and sudden death. Health care providers continue to have difficulty communicating effectively with terminally ill patients and their caregivers regarding end-of-life care preferences, all of which needs to occur earlier rather than later. This article also discusses various means of providing palliative care, and specific issues regarding device therapy, cardiopulmonary resuscitation, and palliative sedation with concurrent discussion of the ethical ramifications and pitfalls of each.
心力衰竭给那些希望在生命末期提供优质且人道护理的临床医生带来了独特的挑战。个体患者死亡率的准确预测因这种伴有反复急性发作和猝死的慢性疾病而变得复杂。医疗保健提供者在就临终护理偏好与绝症患者及其护理人员进行有效沟通方面仍然存在困难，而所有这些都需要尽早而非推迟进行。本文还讨论了提供姑息治疗的各种方法，以及与设备治疗、心肺复苏和姑息性镇静相关的具体问题，并同时讨论了每种方法的伦理影响和陷阱。
