Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2020 May;59(5):1127-1146.e1. doi: 10.1016/j.jpainsymman.2019.12.357. Epub 2019 Dec 19.
Despite significant advances in heart failure (HF) treatment, HF remains a progressive, extremely symptomatic, and terminal disease with a median survival of 2.1 years after diagnosis. HF often leads to a constellation of symptoms, including dyspnea, fatigue, depression, anxiety, insomnia, pain, and worsened cognitive function. Palliative care is an approach that improves the quality of life of patients and their caregivers facing the problems associated with life-threatening illness and therefore is well suited to support these patients. However, historically, palliative care has often focused on supporting patients with malignant disease, rather than a progressive chronic disease such as HF. Predicting mortality in patients with HF is challenging. The lack of obvious transition points in disease progression also raises challenges to primary care providers and specialists to know at what point to integrate palliative care during a patient's disease trajectory. Although therapies for HF often result in functional and symptomatic improvements including health-related quality of life (HRQL), some patients with HF do not demonstrate these benefits, including those patients with a preserved ejection fraction. Provision of palliative care for patients with HF requires an understanding of HF pathogenesis and common medications used for these patients, as well as an approach to balancing life-prolonging and HRQL care strategies. This review describes HF and current targeted therapies and their effects on symptoms, hospital admission rates, exercise performance, HRQL, and survival. Pharmacological interactions with and precautions related to commonly used palliative care medications are reviewed. The goal of this review is to equip palliative care clinicians with information to make evidence-based decisions while managing the balance between optimal disease management and patient quality of life.
尽管心力衰竭 (HF) 的治疗取得了重大进展，但 HF 仍然是一种进行性的、极其有症状的、终末期疾病，诊断后中位生存期为 2.1 年。HF 常导致一系列症状，包括呼吸困难、疲劳、抑郁、焦虑、失眠、疼痛和认知功能恶化。姑息治疗是一种改善面临危及生命疾病相关问题的患者及其照护者生活质量的方法，因此非常适合支持这些患者。然而，历史上，姑息治疗通常侧重于支持恶性疾病患者，而不是 HF 等进行性慢性疾病患者。预测 HF 患者的死亡率具有挑战性。疾病进展中缺乏明显的转折点也给初级保健提供者和专家带来了挑战，他们不知道在患者的疾病轨迹中何时应将姑息治疗纳入其中。尽管 HF 的治疗方法通常会导致功能和症状的改善，包括健康相关生活质量 (HRQL)，但一些 HF 患者并未表现出这些益处，包括射血分数保留的患者。为 HF 患者提供姑息治疗需要了解 HF 的发病机制和这些患者常用的药物，以及平衡延长生命和 HRQL 护理策略的方法。这篇综述描述了 HF 和目前的靶向治疗及其对症状、住院率、运动表现、HRQL 和生存的影响。还回顾了与常用姑息治疗药物的药物相互作用和相关注意事项。本综述的目的是为姑息治疗临床医生提供信息，以便在最佳疾病管理和患者生活质量之间取得平衡时做出基于证据的决策。
