Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.
Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.
Am J Hosp Palliat Care. 2022 Oct;39(10):1194-1202. doi: 10.1177/10499091211069626. Epub 2022 Feb 7.
Patients at an advanced stage of heart failure (AHF), specifically chronic severe symptomatic heart failure defined as New York Heart Association III/IV with hospitalization in the year prior, have high mortality, healthcare utilization, and low palliative care involvement.
The primary objectives were to determine the feasibility of recruiting patients and engaging cardiology and palliative healthcare providers in a program of integrated care for AHF (HeartFull); the proportion of patients who died in non-acute care settings. Secondary objectives were to describe patient-reported outcomes and pre-post comparison of healthcare utilization.
Patients were recruited from an urban academic hospital with expert heart failure care and a 24/7 inpatient and home palliative service. Utilization, disposition, and surveys were collected monthly for up to 20 months.
Of 46 patients referred, 30 (65%) agreed to participate, 27 died during the study period, 19 (70%) died in non-acute care settings, while 8 (30%) died in hospital. We found no significant difference in pre- and post-intervention rates of hospitalization (RR .715; CI .360, 1.388; = .3180), nor emergency visits (RR .678; CI .333, 1.338; = .2590), but both trended downward. No significant changes were observed in patient-reported outcomes.
In an urban academic hospital with palliative care, it was feasible to implement an integrated program for AHF. Patients died at home or in a palliative care unit at rates similar to palliative oncology patients and at higher rates than the general AHF population. HeartFull is now part of clinical practice.
患有晚期心力衰竭（AHF）的患者，特别是在过去一年中因慢性严重症状性心力衰竭而住院的纽约心脏协会 III/IV 级心力衰竭患者，死亡率高、医疗保健利用率低、姑息治疗参与度低。
主要目的是确定为 AHF（HeartFull）招募患者并让心脏病学和姑息治疗提供者参与综合护理计划的可行性；患者在非急性护理环境中死亡的比例。次要目标是描述患者报告的结果以及医疗保健利用情况的前后比较。
从一家拥有专业心力衰竭护理和 24/7 住院和家庭姑息治疗服务的城市学术医院招募患者。每月收集一次利用情况、处置情况和调查结果，最长可达 20 个月。
在被转介的 46 名患者中，有 30 名（65%）同意参与，在研究期间有 27 名患者死亡，19 名（70%）在非急性护理环境中死亡，而 8 名（30%）在医院死亡。我们没有发现干预前后住院率（RR.715；CI.360, 1.388； =.3180）和急诊就诊率（RR.678；CI.333, 1.338； =.2590）有显著差异，尽管两者都呈下降趋势。患者报告的结果没有观察到显著变化。
在一家拥有姑息治疗的城市学术医院中，实施 AHF 综合治疗计划是可行的。患者在家中或姑息治疗病房死亡的比例与姑息治疗肿瘤患者相似，高于一般 AHF 人群。HeartFull 现在已成为临床实践的一部分。
