Division of Cardiology at Department of Medicine at University of North Carolina at Chapel Hill School of Medicine, 160 Dental Circle, Chapel Hill, NC 27599-7075.
FP Essent. 2021 Jul;506:31-42.
End-stage heart failure (HF) is associated with an extremely poor prognosis. Progressive and/or persistent HF signs and symptoms in the setting of optimal therapy is the hallmark of more advanced disease. Physicians must be able to recognize patients with features of refractory HF to aid in timely evaluation for advanced therapy options. Left ventricular assist device implantation and heart transplantation prolong survival in patients with end-stage HF, but are options only for select patients. Timely referral for evaluation is necessary to prevent secondary irreversible end-organ dysfunction and to ascertain whether there are factors that can be addressed and corrected. All patients with end-stage HF should be offered referral for palliative care to aid in symptom management and improve quality of life. In addition, for patients who are not candidates for advanced therapy options, hospice should be discussed. In some cases, palliative home inotrope infusion can be considered for symptom management.
终末期心力衰竭（HF）与极差的预后相关。在最佳治疗的情况下，HF 症状和体征的进行性和/或持续性是更晚期疾病的标志。医生必须能够识别出具有难治性 HF 特征的患者，以帮助及时评估高级治疗选择。左心室辅助装置植入和心脏移植可延长终末期 HF 患者的生存时间，但仅适用于特定患者。及时转诊进行评估是必要的，以防止继发性不可逆转的终末器官功能障碍，并确定是否存在可以解决和纠正的因素。所有终末期 HF 患者均应提供姑息治疗转诊，以帮助控制症状并提高生活质量。此外，对于不适合高级治疗选择的患者，应讨论临终关怀。在某些情况下，姑息性家庭正性肌力输注可用于控制症状。
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