Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, San Francisco, California.
Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California.
J Palliat Med. 2019 Dec;22(12):1583-1588. doi: 10.1089/jpm.2018.0633. Epub 2019 May 17.
People with heart failure (HF) have high morbidity and mortality and may benefit from palliative care (PC). To pilot a randomized, clinical trial of a PC intervention for people with HF. Participants were randomized to usual care (UC) or intervention (UC plus specialty PC) between January 2012 and December 2013. The initial PC consultation was conducted in-hospital, with six additional contacts from the PC team over six months. The study was undertaken in a large, urban, academic medical center with patients ( = 30) with New York Heart Association HF Class II-IV. Patients completed a survey at baseline, three and six months, assessing pain, dyspnea, depression, and quality of life (QoL). Although there were significant improvements in mean scores from baseline to six months for pain (4.3 vs. 2.4, = 0.05), dyspnea (3.9 vs. 2.2, = 0.03), and QoL (59.2 vs. 42.7, = 0.001), there were no differences between study groups over time. On average, participants in the intervention group received 5 out of 6 contacts and were satisfied with the intervention. The intervention was well accepted by patients, safe, and feasible. Our findings suggest that PC interventions for people with HF should match the PC needs of the patient. Given the trajectory of HF, studies may need to recruit outpatients and follow patients for a longer period to fully evaluate the impact of PC interventions. Clinical trials Identifier: NCT01461681.
心力衰竭（HF）患者的发病率和死亡率较高，可能受益于姑息治疗（PC）。旨在为 HF 患者的 PC 干预措施进行一项随机临床试验的试点研究。参与者被随机分配到常规护理（UC）或干预组（UC 加专业 PC），时间从 2012 年 1 月到 2013 年 12 月。初始 PC 咨询在医院内进行，PC 团队在六个月内进行了六次额外的联系。该研究在一家大型城市学术医疗中心进行，患者（ = 30）患有纽约心脏协会 HF 分级 II-IV。患者在基线、三个月和六个月时完成了一项调查，评估疼痛、呼吸困难、抑郁和生活质量（QoL）。尽管疼痛（4.3 对 2.4， = 0.05）、呼吸困难（3.9 对 2.2， = 0.03）和 QoL（59.2 对 42.7， = 0.001）的平均评分从基线到六个月均有显著改善，但两组之间在时间上没有差异。干预组的参与者平均接受了 6 次联系中的 5 次，并对干预措施表示满意。干预措施得到了患者的认可，安全可行。我们的研究结果表明，HF 患者的 PC 干预措施应符合患者的 PC 需求。鉴于 HF 的发展轨迹，研究可能需要招募门诊患者并随访患者更长时间，以全面评估 PC 干预措施的影响。临床试验标识符：NCT01461681。
