Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA.
Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA.
J Pain Symptom Manage. 2023 Jun;65(6):500-509. doi: 10.1016/j.jpainsymman.2023.01.016. Epub 2023 Feb 1.
Physical frailty is emerging as a potential "trigger" for palliative care (PC) consultation, but the PC needs of physically frail persons with heart failure (HF) in the outpatient setting have not been well described.
This study describes the PC needs of community dwelling, physically frail persons with HF.
We included persons with HF ≥50 years old who experienced ≥1 hospitalization in the prior year and excluded those with moderate/severe cognitive impairment, hospice patients, or non-English speaking persons. Measures included the FRAIL scale (0-5: 0 = robust, 1-2 = prefrail, 3-5 = frail) and the Integrated Palliative Outcome Scale (IPOS) (17 items, score 0-68; higher score = higher PC needs). Multiple linear regression tested the association between frailty group and palliative care needs.
Participants (N = 286) had a mean age of 68 (range 50-92) were majority male (63%) and White (68%) and averaged two hospitalizations annually. Most were physically frail (44%) or prefrail (41%). Mean PC needs (IPOS) score was 19.7 (range 0-58). On average, participants reported 5.86 (SD 4.28) PC needs affecting them moderately, severely, or overwhelmingly in the last week. Patient-perceived family/friend anxiety (58%) weakness/lack of energy (58%), and shortness of breath (47%) were the most prevalent needs. Frail participants had higher mean PC needs score (26) than prefrail (16, P < 0.001) or robust participants (11, P < 0.001). Frail participants experienced an average of 8.32 (SD 3.72) moderate/severe/overwhelming needs compared to prefrail (4.56, SD 3.77) and robust (2.39, SD 2.91) participants (P < 0.001). Frail participants reported higher prevalence of weakness/lack of energy (83%), shortness of breath (66%), and family/friend anxiety (69%) than prefrail (48%, 39%, 54%) or robust (13%, 14%, 35%) participants (P < 0.001).
Physically frail people with HF have higher unmet PC needs than those who are nonfrail. Implementing PC needs and frailty assessments may help identify vulnerable patients with unmet needs requiring further assessment and follow-up.
身体虚弱正逐渐成为姑息治疗（PC）咨询的一个潜在“触发因素”，但在门诊环境中，患有心力衰竭（HF）的身体虚弱者的 PC 需求尚未得到充分描述。
本研究描述了社区居住的身体虚弱的 HF 患者的 PC 需求。
我们纳入了年龄≥50 岁且过去 1 年中经历过≥1 次住院治疗的 HF 患者，并排除了中度/重度认知障碍、临终关怀患者或非英语患者。评估包括衰弱量表（FRAIL 量表）（0-5：0=强壮，1-2=衰弱前期，3-5=衰弱）和综合姑息治疗结局量表（IPOS）（17 项，评分 0-68；分数越高表示 PC 需求越高）。采用多元线性回归检验衰弱组与 PC 需求之间的关联。
参与者（N=286）平均年龄为 68 岁（范围 50-92），其中 63%为男性，68%为白人，平均每年住院 2 次。大多数患者身体虚弱（44%）或衰弱前期（41%）。平均 PC 需求（IPOS）评分为 19.7（范围 0-58）。平均而言，参与者在过去一周内报告了 5.86（SD 4.28）项中等、严重或压倒性影响他们的 PC 需求。患者感知到的家属/朋友焦虑（58%）、乏力/缺乏精力（58%）和呼吸急促（47%）是最常见的需求。虚弱组的平均 PC 需求评分（26）高于衰弱前期组（16，P＜0.001）和强壮组（11，P＜0.001）。与衰弱前期组（4.56，SD 3.77）和强壮组（2.39，SD 2.91）相比，虚弱组经历的平均中度/严重/压倒性需求为 8.32（SD 3.72）（P＜0.001）。虚弱组报告乏力/缺乏精力（83%）、呼吸急促（66%）和家属/朋友焦虑（69%）的比例高于衰弱前期组（48%、39%、54%）和强壮组（13%、14%、35%）（P＜0.001）。
HF 合并身体虚弱的患者比非虚弱患者有更高的未满足的 PC 需求。实施 PC 需求和衰弱评估可能有助于识别有未满足需求的脆弱患者，这些患者需要进一步评估和随访。
