Libin Cardiovascular Institute and Division of Palliative Care, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2018 Jul;34(7):914-924. doi: 10.1016/j.cjca.2018.03.018. Epub 2018 Apr 6.
The landscape of patient care at the beginning of the 19th century was dramatically different than it is today. With few good treatment options, illness courses were generally brief. Near the end of life, patients were attended to by spiritual advisors, not health care professionals. Death typically occurred at home, surrounded by friends and family. Moving to the present time, decades of medical advances have significantly improved life expectancy. Cardiology has particularly benefited from many of these advances. Cardiac patients are initiated on optimal medication regimens. As disease burdens progress, interventions such as implantable defibrillators and cardiac resynchronization pacing systems become options for many patients. With further clinical deterioration, select patients might be candidates for ventricular assist devices and heart transplants. These advances have unquestionably improved the prognosis with advanced cardiovascular illnesses. However, they have also changed patient and family attitudes about death and dying, to the point where we have effectively "medicalized our mortality." The importance of introducing palliative care to the cardiac patient population is now well recognized, with the major cardiovascular societies incorporating palliative care principles into their guideline and consensus statement documents. However, despite this recognition, few cardiac patients get access to palliative care and other resources such as hospice. In this article the existing literature on this topic is reviewed and opportunities for developing and fostering a more collaborative relationship between the disciplines of cardiology and palliative care are discussed.
19 世纪初的患者护理格局与今天大不相同。由于治疗选择有限，疾病的病程通常较短。在生命的最后阶段，患者由精神顾问照顾，而不是医疗保健专业人员。死亡通常发生在家庭中，周围是朋友和家人。现在，几十年的医学进步极大地提高了预期寿命。心脏病学尤其受益于许多这些进步。心脏患者开始接受最佳药物治疗方案。随着疾病负担的进展，植入式除颤器和心脏再同步起搏系统等干预措施成为许多患者的选择。随着临床病情进一步恶化，一些患者可能适合心室辅助装置和心脏移植。这些进展无疑改善了晚期心血管疾病的预后。然而，它们也改变了患者和家属对死亡和临终的态度，以至于我们有效地“将死亡医学化”。现在，人们已经充分认识到向心脏患者群体引入姑息治疗的重要性，主要的心血管学会已将姑息治疗原则纳入其指南和共识声明文件。然而，尽管有了这种认识，很少有心脏患者能够获得姑息治疗和其他资源，如临终关怀。本文回顾了该主题的现有文献，并讨论了在心脏病学和姑息治疗之间发展和培养更具协作性关系的机会。
