The Tufts University School of Medicine, Boston, Massachusetts.
The Tufts University School of Medicine, Boston, Massachusetts; Division of Academic Affairs, Maine Medical Center, Portland, Maine.
J Card Fail. 2022 Oct;28(10):1568-1571. doi: 10.1016/j.cardfail.2022.05.016. Epub 2022 Jun 9.
Guidelines recommend goals of care conversations (GOCC) and specialty palliative care at the time of initiation of palliative inotropes for patients with advanced heart failure. The extent to which GOCC are occurring, the content of the GOCC, and the frequency of palliative care involvement is unknown.
We conducted a retrospective chart review of all patients discharged from a tertiary medical center between October 2015 and April 2020 initiated on continuous palliative inotropes. We identified 53 patients who were discharged on continuous palliative inotropes. Most patients (46/53 [87%]) had a documented GOCC, including discussions around preferences for life-sustaining treatments, hospice, and/or prognosis. However, just more than one-half of the patients (55% [15/27]) with an ICD had a documented discussion regarding preferences for ICD deactivation. Patients seen by palliative care were more likely to have a documented discussion about ICD deactivation (68% vs 0%, P = .0098). The frequency of palliative care consultation and documented GOCC conversations increased over time.
Although we observed overall high rates of documented GOCC, there is room for improving the rate of discussions with patients about whether they wish to have their ICD deactivated. Future research should test interventions to improve the frequency of ICD discussions.
指南建议在开始为晚期心力衰竭患者使用姑息性正性肌力药物时进行姑息治疗目标对话（GOCC）和专科姑息治疗。目前尚不清楚 GOCC 的发生频率、GOCC 的内容以及姑息治疗的参与频率。
我们对 2015 年 10 月至 2020 年 4 月期间在三级医疗中心出院并开始使用持续姑息性正性肌力药物的所有患者进行了回顾性图表审查。我们确定了 53 名接受持续姑息性正性肌力药物治疗的患者。大多数患者（46/53 [87%]）有记录的 GOCC，包括对维持生命治疗、临终关怀和/或预后的偏好的讨论。然而，只有一半以上（15/27 [55%]）有 ICD 的患者有记录的关于 ICD 去激活偏好的讨论。接受姑息治疗的患者更有可能记录关于 ICD 去激活的讨论（68% 与 0%，P=0.0098）。姑息治疗咨询和记录的 GOCC 对话的频率随时间增加。
尽管我们观察到总体上有很高的记录 GOCC 率，但仍有改进与患者讨论是否希望去激活 ICD 的空间。未来的研究应该测试干预措施，以提高 ICD 讨论的频率。
