Romano' Massimo
Organizing Committee Postgraduate Master in Palliative Care, University of Milan, 20122 Milan, Italy.
J Clin Med. 2022 Nov 24;11(23):6933. doi: 10.3390/jcm11236933.
Heart failure is a clinical syndrome with increasing prevalence, high morbidity and mortality. It is characterized by high symptom burden, poor quality of life and high economic costs. This implies that the heart failure (HF) patients who receive palliative care (PC) have needs similar to cancer patients, but which are often unmet. This paper analyzes the main unresolved issues regarding the relationship between HF patients and the referral to an early PC program. These issues are presented as ten questions related to which patients should be admitted to PC and at what stage of their disease. Furthermore, the barriers opposing to referral to PC, the role of cardiologists and PC physicians within the care team, the gap between the scientific societies' suggestions and the real world, the right time to promote patients' awareness and shared decision making, regarding prognosis, end of life wishes and choices, with reference also to cardiac implantable devices' deactivation, are discussed. These unresolved questions support the need to reevaluate programs and specific models in achieving equal access to palliative care interventions for HF patients, which is still mainly offered to patients with cancer.
心力衰竭是一种患病率不断上升、发病率和死亡率高的临床综合征。其特点是症状负担重、生活质量差且经济成本高。这意味着接受姑息治疗（PC）的心力衰竭（HF）患者有着与癌症患者相似的需求，但这些需求往往未得到满足。本文分析了关于HF患者与转诊至早期PC项目之间关系的主要未解决问题。这些问题以十个问题的形式呈现，涉及哪些患者应接受PC治疗以及在其疾病的哪个阶段接受治疗。此外，还讨论了阻碍转诊至PC的因素、心脏病专家和PC医生在护理团队中的作用、科学协会建议与现实世界之间的差距、促进患者对预后、临终愿望和选择的认识以及共同决策的合适时机，同时还提及了心脏植入式设备的停用。这些未解决的问题表明有必要重新评估项目和具体模式，以实现HF患者平等获得姑息治疗干预的机会，目前姑息治疗仍主要提供给癌症患者。
