St Joseph's Health Care London, London, Ontario, Canada; Western University, London, Ontario, Canada.
CorHealth Ontario, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada.
Can J Cardiol. 2020 Feb;36(2):234-243. doi: 10.1016/j.cjca.2019.11.012. Epub 2019 Nov 20.
Globally, there are ∼ 26 million people living with heart failure (HF), 50% of them with reduced ejection fraction, costing countries billions of dollars each year. Improvements in treatment of cardiovascular diseases, including advanced HF, have allowed an unprecedented number of patients to survive into old age. Despite these advances, patients with HF deteriorate and often require advanced therapies. As the proportion of elderly patients in the population increases, there will be an increasing number of patients to be evaluated for advanced therapies and an increasing number that do not qualify for, won't be considered for, or decline orthotopic heart transplantation. The purpose of this article is to review the benefits of palliative care (PC), exercise-based cardiac rehabilitation (ExCR), device therapy (cardiac resynchronization therapy and mitral clip), and mechanical circulatory support (MCS) in advanced HF patients who are transplant ineligible. PC interventions should be introduced early in the course of a patient's diagnosis to manage symptoms, address goals of care, and improve patient-centered outcomes. Further improvement in health-related quality of life as well as functional capacity can be achieved safely in patients with advanced HF through patient participation in ExCR. Device therapy and MCS can reduce HF hospitalizations and improve survival. In fact, early survival with MCS approaches that of heart transplantation. Despite their being transplant ineligible, there are a variety of treatment options available to patients to improve their quality of life, decrease hospitalizations, and potentially improve mortality.
全球有大约 2600 万人患有心力衰竭（HF），其中 50%为射血分数降低，每年给各国造成数十亿美元的损失。心血管疾病治疗的进步，包括晚期 HF 的治疗，使大量患者能够存活到老年。尽管取得了这些进展，但 HF 患者的病情仍在恶化，他们往往需要接受先进的治疗。随着老年患者在人口中所占比例的增加，需要评估先进治疗方法的患者人数将会增加，而不符合条件、不考虑或拒绝接受心脏移植的患者人数也将会增加。本文的目的是回顾姑息治疗（PC）、基于运动的心脏康复（ExCR）、器械治疗（心脏再同步治疗和二尖瓣夹合术）和机械循环支持（MCS）在不适合心脏移植的晚期 HF 患者中的应用。PC 干预措施应在患者诊断过程的早期引入，以管理症状、解决护理目标，并改善以患者为中心的结局。通过患者参与 ExCR，晚期 HF 患者的健康相关生活质量和功能能力可以得到安全改善。器械治疗和 MCS 可减少 HF 住院次数并提高生存率。事实上，MCS 的早期生存率接近心脏移植。尽管这些患者不适合心脏移植，但仍有多种治疗方案可供患者选择，以提高他们的生活质量、减少住院次数，并可能降低死亡率。
