Kurozumi Yuma, Oishi Shogo, Sugano Yasuo, Sakashita Akihiro, Kotooka Norihiko, Suzuki Makoto, Higo Taiki, Yumino Dai, Takada Yasuko, Maeda Seiko, Yamabe Saori, Washida Koichi, Takahashi Tomonori, Ohtani Tomohito, Sakata Yasushi, Sato Yukihito
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, 660-8550, Hyogo, Japan.
Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
Heart Vessels. 2019 Mar;34(3):452-461. doi: 10.1007/s00380-018-1261-y. Epub 2018 Sep 20.
Palliative care for end-stage heart failure should be provided by a multidisciplinary team. However, the influence of each occupational category on patients receiving palliative care for end-stage heart failure remains unclear. Thus, this study investigated the relationships between palliative care conferences and positive outcomes of palliative care for end-stage heart failure patients. We sent questionnaires to all cardiology training hospitals authorized by the Japanese Circulation Society (n = 1004); of these, responses from the directors at 554 institutions were analyzed. We divided the responding institutions into two groups according to their implementation of palliative care conferences for patients with end-stage heart failure. The institutions that had held such conferences (n = 223) had a larger number of hospital beds, beds in the cardiovascular department, and patients admitted to the cardiovascular department, compared with institutions that had not held these conferences (n = 321). The usage rates of opioids, non-steroidal anti-inflammatory drugs, and sedatives were significantly higher in institutions that held these conferences. Multivariate analysis revealed that nutritionists and medical social workers had greater involvement in the improvement of mental symptoms and ensuring that patients could stay where they wished, respectively. The presence of palliative care physicians, physical therapists, or pharmacists was associated with multiple positive outcomes. This study indicated that there are possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure.
晚期心力衰竭的姑息治疗应由多学科团队提供。然而,各职业类别对接受晚期心力衰竭姑息治疗患者的影响尚不清楚。因此,本研究调查了姑息治疗会议与晚期心力衰竭患者姑息治疗积极结果之间的关系。我们向日本循环学会授权的所有心脏病学培训医院(n = 1004)发送了问卷;其中,对554家机构主任的回复进行了分析。我们根据是否为晚期心力衰竭患者举办姑息治疗会议,将回复机构分为两组。与未举办此类会议的机构(n = 321)相比,举办过此类会议的机构(n = 223)拥有更多的病床、心血管科病床以及心血管科收治的患者。举办这些会议的机构中阿片类药物、非甾体抗炎药和镇静剂的使用率显著更高。多变量分析显示,营养师和医务社会工作者分别在改善精神症状和确保患者能够在其希望的地方停留方面有更大的参与度。姑息治疗医生、物理治疗师或药剂师的存在与多个积极结果相关。本研究表明,在对晚期心力衰竭患者进行姑息治疗时,姑息治疗会议与积极结果之间可能存在关联。