Romano' Massimo
Centro Universitario Interdipartimentale di Ricerca in Cure Palliative, Università di Milano, via Ripamonti 428, 20136 Milano, Italy.
Healthcare (Basel). 2019 Feb 19;7(1):30. doi: 10.3390/healthcare7010030.
In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden and mortality rate and an increased length of stay. In this context, palliative care programs, including withholding/withdrawing life support treatments or the deactivation of implanted cardiac devices, are frequently needed, according to the specific guidelines of scientific societies. However, the implementation of these recommendations in clinical practice is still inconsistent. In this review, we analyze the reasons for this gap and the main cultural changes that are required to improve the care of patients with advanced illness.
在过去几年中，入住心脏重症监护病房（CICU）的患者的临床和流行病学特征发生了重要变化。护理重点已从急性冠状动脉综合征患者转向老年患者，这些老年患者非缺血性心血管疾病患病率高，非心血管合并症负担重：这两者都增加了患者发生危及生命的危急情况的易感性。这些情况伴有显著的症状负担、死亡率以及住院时间延长。在此背景下，根据科学协会的具体指南，经常需要姑息治疗方案，包括停止/撤销生命支持治疗或停用植入式心脏装置。然而，这些建议在临床实践中的实施仍然不一致。在本综述中，我们分析了造成这一差距的原因以及改善晚期疾病患者护理所需的主要文化变革。
