Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
J Am Coll Cardiol. 2017 Sep 5;70(10):1276-1289. doi: 10.1016/j.jacc.2017.07.735.
Advances in medicine have changed how patients experience the end of life. With longer life spans, there has also been an increase in years lived with disability. The clustering of illnesses in the last years of life is particularly pronounced in patients with cardiovascular disease. At the end of life, patients with cardiovascular disease are more symptomatic, less likely to die at home, and less likely to receive high-quality palliative care. Social determinants have created widening disparities in end-of-life care. The increasing complexity and duration of care have resulted in an epidemic of caregiver burden. Modern medical care has also resulted in new ethical challenges, for example, those related to deactivation of cardiac devices, such as pacemakers, defibrillators, and mechanical circulatory support. Recommendations to improve end-of-life care for patients with cardiovascular disease include optimizing metrics to assess quality, ameliorating disparities, enhancing education and research in palliative care, overcoming disparities, and innovating palliative care delivery and reimbursement.
医学的进步改变了患者临终的体验。随着寿命的延长，残疾生活年数也有所增加。在心血管疾病患者的生命末期，疾病的聚集更为明显。临终时，心血管疾病患者的症状更为明显，在家中去世的可能性较小，接受高质量姑息治疗的可能性也较小。社会决定因素导致临终护理的差距不断扩大。护理的复杂性和持续时间的增加导致了照顾者负担的流行。现代医疗也带来了新的伦理挑战，例如与心脏设备（如起搏器、除颤器和机械循环支持）停用相关的挑战。改善心血管疾病患者临终关怀的建议包括优化评估质量的指标、改善差异、加强姑息治疗教育和研究、克服差异以及创新姑息治疗的提供和报销。
