心力衰竭患者的症状负担、心理社会困扰和姑息治疗需求：一项横断面探索性初步研究。
Symptom burden, psychosocial distress and palliative care needs in heart failure - A cross-sectional explorative pilot study.
机构信息
Department for Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
Department for Oncology, University Cancer Center Hamburg, Hamburg, Germany.
出版信息
Clin Res Cardiol. 2023 Jan;112(1):49-58. doi: 10.1007/s00392-022-02017-y. Epub 2022 Apr 14.
BACKGROUND
Beyond guideline-directed treatments aimed at improving cardiac function and prognosis in heart failure (HF), patient-reported outcomes have gained attention.
PURPOSE
Using a cross-sectional approach, we assessed symptom burden, psychosocial distress, and potential palliative care (PC) needs in patients with advanced stages of HF.
METHODS
At a large tertiary care center, we enrolled HF patients in an exploratory pilot study. Symptom burden and psychosocial distress were assessed using the MIDOS (Minimal Documentation System for Patients in PC) questionnaire and the Distress Thermometer (DT), respectively. The 4-item Patient Health Questionnaire (PHQ-4) was used to screen for anxiety and depression. To assess PC needs, physicians used the "Palliative Care Screening Tool for HF Patients".
RESULTS
We included 259 patients, of whom 137 (53%) were enrolled at the Heart Failure Unit (HFU), and 122 (47%) at the outpatient clinic (OC). Mean age was 63 years, 72% were male. New York Heart Association class III or IV symptoms were present in 56%. With a mean 5-year survival 64% (HFU) vs. 69% (OC) calculated by the Seattle Heart Failure Model, estimated prognosis was comparatively good. Symptom burden (MIDOS score 8.0 vs. 5.4, max. 30 points, p < 0.001) and level of distress (DT score 6.0 vs. 4.8, max. 10 points, p < 0.001) were higher in hospitalised patients. Clinically relevant distress was detected in the majority of patients (HFU 76% vs. OC 57%, p = 0.001), and more than one third exhibited at least mild symptoms of depression or anxiety. Screening for PC needs revealed 82% of in- and 52% of outpatients fulfil criteria for specialized palliative support.
CONCLUSION
Despite a good prognosis, we found multiple undetected and unaddressed needs in an advanced HF cohort. This study's tools and screening results may help to early explore these needs, to further improve integrated HF care.
背景
除了旨在改善心力衰竭（HF）患者心功能和预后的指南指导治疗外，患者报告的结局也受到了关注。
目的
我们采用横断面研究方法，评估了晚期 HF 患者的症状负担、心理社会困扰和潜在的姑息治疗（PC）需求。
方法
在一家大型三级保健中心，我们对 HF 患者进行了一项探索性试点研究。使用 MIDOS（PC 患者最小记录系统）问卷和 DT（Distress Thermometer）分别评估症状负担和心理社会困扰。使用 PHQ-4（4 项患者健康问卷）筛查焦虑和抑郁。为了评估 PC 的需求，医生使用了“HF 患者 PC 筛查工具”。
结果
我们纳入了 259 名患者，其中 137 名（53%）在心力衰竭病房（HFU），122 名（47%）在门诊（OC）。平均年龄为 63 岁，72%为男性。56%的患者出现纽约心脏协会（NYHA）III 或 IV 级症状。根据西雅图心力衰竭模型计算的 5 年生存率为 64%（HFU）与 69%（OC），预计预后相对较好。与住院患者相比，症状负担（MIDOS 评分 8.0 与 5.4，最高 30 分，p<0.001）和痛苦程度（DT 评分 6.0 与 4.8，最高 10 分，p<0.001）更高。大多数患者都存在明显的心理困扰（HFU 为 76%，OC 为 57%，p=0.001），超过三分之一的患者表现出至少轻度的抑郁或焦虑症状。PC 需求筛查显示，82%的住院患者和 52%的门诊患者符合接受专业姑息治疗的标准。
结论
尽管预后良好，但我们在晚期 HF 患者队列中发现了多种未被发现和未得到满足的需求。本研究的工具和筛查结果可能有助于早期探索这些需求，进一步改善 HF 的综合治疗。
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