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从大学附属医院心内科转诊至专科姑息治疗病房的患者特征:一项长达 11 年的回顾性纵向研究。

Profiles of patients referred to specialized palliative care from the cardiology department at a university hospital: an 11-year longitudinal retrospective study.

机构信息

Mobile Palliative Care Team, University Hospital Besançon, Besançon, France.

Inserm CIC1431, University Hospital Besançon, Besançon, France.

出版信息

Panminerva Med. 2023 Dec;65(4):467-472. doi: 10.23736/S0031-0808.23.04829-2. Epub 2023 May 22.

Abstract

BACKGROUND

Although the majority of patients with cardiovascular diseases (CVD) have a significant symptom burden and progressive course towards the end of life, only a small proportion of patients currently receive palliative care. The current referral practices to palliative care from the cardiology department need to be scrutinized. The current study aimed to examine: 1) the clinical profile; 2) time between referral to palliative care and death; and 3) place of death for CVD patients who were referred to palliative care from a cardiology department.

METHODS

This retrospective descriptive study included all patients who were referred to the mobile palliative care team from the cardiology unit in the University Hospital of Besançon in France between January 2010 and December 2020. Information was extracted from the medical hospital files.

RESULTS

A total of 142 patients were included, of whom 135 (95%) died. The mean age at the time of death was 76±14 years. The median time between referral to palliative care and death was 9 days. Most patients had chronic heart failure (54%). A total of 17 patients (13%) died at home.

CONCLUSIONS

This study showed that referral of patients to palliative care from the cardiology department is suboptimal and a large proportion of patients die in the hospital setting. Further prospective studies are warranted to investigate whether these dispositions correspond to patients' wishes and end-of-life care needs, and should investigate how the integration of palliative care into the care of cardiovascular patients can be improved.

摘要

背景

尽管大多数心血管疾病 (CVD) 患者都有显著的症状负担,并在生命末期逐渐恶化,但目前只有一小部分患者接受姑息治疗。目前,心内科向姑息治疗的转介实践需要进行审查。本研究旨在探讨:1)临床特征;2)从心内科转介至姑息治疗到死亡的时间;以及 3)从心内科转介至姑息治疗的 CVD 患者的死亡地点。

方法

本回顾性描述性研究纳入了 2010 年 1 月至 2020 年 12 月期间,从法国贝桑松大学附属医院心内科转介至移动姑息治疗团队的所有患者。信息从医院病历中提取。

结果

共纳入 142 例患者,其中 135 例(95%)死亡。死亡时的平均年龄为 76±14 岁。从转介至姑息治疗到死亡的中位数时间为 9 天。大多数患者患有慢性心力衰竭(54%)。共有 17 例(13%)患者在家中死亡。

结论

本研究表明,心内科向姑息治疗的转介并不理想,且很大一部分患者在医院环境中死亡。需要进一步进行前瞻性研究,以调查这些处置是否符合患者的意愿和临终关怀需求,并应研究如何改善姑息治疗与心血管患者治疗的整合。

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