Heart Failure, Department of Cardiology, Lillebaelt Hospital Vejle, Vejle, Denmark.
Danish Society of Cardiology, Copenhagen, Denmark.
J Palliat Med. 2020 Sep;23(9):1159-1166. doi: 10.1089/jpm.2019.0566. Epub 2020 May 6.
According to the World Health Organization, palliative care must be available for everyone with life-threatening diseases. However, in daily practice the primary focus worldwide is on cancer patients. The aim of the article was to generate a national position statement as the first step in implementing palliative care in severe heart disease with focus on advanced heart failure, including tools to identify the need for and timing of palliative care and how palliative care could be organized in Denmark. A task force was formed in the Danish Society of Cardiology Heart Failure Working Group, and the position statement was prepared in collaboration with members from a broad group of specialties, including palliative medicine. Because of major gaps in evidence, the position statement was based on small and low-quality studies and clinical practice statements. This position statement was aligned with the European Society of Cardiology recommendation, focusing on relieving suffering from the early disease stages parallel to standard care and supplementing life-prolonging treatment. The statement delivers practical guidance on clinical aspects and managing symptoms during the three stages of advanced heart disease. Furthermore, the statement describes the importance of communication and topics to be broached, including deactivating implantable cardioverter defibrillators. The statement recommends a targeted effort on organizational strategies using high-quality assessment tools and emphasizes multidisciplinary and intersectoral collaboration. Danish cardiologists supported by allied professionals acknowledge the importance of palliative care in advanced heart disease. This national position statement intended to inform and influence policy and practice and can hopefully inspire other countries to take action toward implementing palliative care in advanced heart disease.
根据世界卫生组织的规定，所有患有危及生命疾病的人都必须获得姑息治疗。然而，在日常实践中，全球的主要关注点都集中在癌症患者身上。本文的目的是生成一份国家立场声明，作为在严重心脏病中实施姑息治疗的第一步，重点是晚期心力衰竭，包括确定需要姑息治疗的工具以及姑息治疗的时机，以及如何在丹麦组织姑息治疗。丹麦心脏病学会心力衰竭工作组成立了一个工作组，该立场声明是与来自广泛专业领域的成员合作编写的，包括姑息医学。由于证据存在重大差距，该立场声明基于小型和低质量的研究和临床实践声明。该立场声明与欧洲心脏病学会的建议一致，重点是在标准治疗的同时缓解早期疾病阶段的痛苦，并补充延长生命的治疗。该声明就晚期心脏病的三个阶段的临床方面和症状管理提供了实用指导。此外，该声明还描述了沟通的重要性以及需要讨论的话题，包括停用植入式心脏复律除颤器。该声明建议采取有针对性的组织策略，使用高质量的评估工具，并强调多学科和跨部门的合作。得到相关专业人员支持的丹麦心脏病专家承认晚期心脏病姑息治疗的重要性。这份国家立场声明旨在为政策和实践提供信息和影响，并希望能够激励其他国家采取行动，在晚期心脏病中实施姑息治疗。
