姑息治疗方法与终末期心力衰竭入院——我们做对了吗？

The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right?

机构信息

Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.

Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Department of Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Vic, Australia; Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Vic, Australia.

出版信息

Heart Lung Circ. 2022 Jun;31(6):841-848. doi: 10.1016/j.hlc.2022.01.002. Epub 2022 Feb 11.

DOI:10.1016/j.hlc.2022.01.002

PMID:35153151

Abstract

BACKGROUND

Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life.

AIM

To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure.

DESIGN

Retrospective medical record review of all deaths from chronic heart failure (January 2010 to December 2019).

PARTICIPANTS

Admissions with chronic heart failure resulting in death were analysed from an Australian tertiary referral centre.

RESULTS

The cohort (n=517) were elderly (median age 83.8 years IQR=77.6-88.7) and male (55.1%). Common comorbidities were ischaemic heart disease (n=293 56.7%) and atrial fibrillation (n=289 55.9%). Life sustaining interventions occurred in 97 (18.8%) patients. In 31 (6.0%) patients referral to specialist palliative care occurred prior to, and in 263 (50.9%) during, the terminal admission. Opioids were prescribed to 440 (85.1%) patients. Comfort care was the documented goal in 158 patients (30.6%). A palliative approach was significantly associated with prior admission in the preceding 12 months (OR=1.5 95% CI=1.0-2.1 p<0.043), receiving outpatient care (OR=2.6 95% CI=1.6-4.1 p<0.01), and admissions in the latter half of the decade (OR=1.5 95% CI=1.0-2.0 p<0.038).

CONCLUSION

Despite greater adoption of a palliative approach in the terminal admission over the last decade, a significant proportion of patients receive palliative care late, just prior to death.

摘要

背景

慢性心力衰竭死亡率高，早期提供姑息治疗支持复杂的决策，并提高生活质量。

目的

探讨在因心力衰竭住院死亡的患者生命的最后 12 个月内是否以及何时采用姑息治疗方法。

设计

对 2010 年 1 月至 2019 年 12 月所有因慢性心力衰竭死亡的患者进行回顾性病历审查。

参与者

分析来自澳大利亚三级转诊中心的因慢性心力衰竭住院死亡的患者。

结果

队列（n=517）年龄较大（中位数年龄 83.8 岁，IQR=77.6-88.7）且为男性（55.1%）。常见的合并症包括缺血性心脏病（n=293，56.7%）和心房颤动（n=289，55.9%）。有 97 名（18.8%）患者接受了维持生命的干预措施。在 31 名（6.0%）患者中，在终末期入院前，有 263 名（50.9%）患者转诊至专科姑息治疗。440 名（85.1%）患者开了阿片类药物。158 名（30.6%）患者记录的目标是舒适护理。姑息治疗方法与前 12 个月的入院（OR=1.5，95%CI=1.0-2.1，p<0.043）、门诊护理（OR=2.6，95%CI=1.6-4.1，p<0.01）和过去十年下半年的入院（OR=1.5，95%CI=1.0-2.0，p<0.038）显著相关。