Division of Palliative Medicine, Department of Internal Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA.
J Palliat Med. 2023 Dec;26(12):1678-1684. doi: 10.1089/jpm.2022.0596. Epub 2023 Oct 25.
Characteristics of patients undergoing outpatient evaluation for advanced cardiac therapies are largely unknown. To describe demographics, baseline quality of life, and frailty of patients undergoing evaluation for advanced therapies at the time of presentation for evaluation in an outpatient cardiac palliative care clinic and examine key quality of life differences across patients. Retrospective chart review to report baseline demographics and quality of life. Patients at a large academic medical center in the United States referred for advanced cardiac therapies in 2021. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale; quality of life was measured using the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) tool; and frailty was measured using the Fried Frailty Phenotype. Differences in quality of life by disease etiology, demographic characteristics, and frailty were assessed. Fifty-four patients were seen in the outpatient cardiac palliative care clinic for advanced therapy evaluation. Most were Caucasian (80%) and male (74%). Patients traveled an average of 61 minutes to the clinic. All but five lived in a rural, medically underserved, or health professional shortage area. Forty percent scored abnormal or borderline abnormal for anxiety; 22% scored abnormal or borderline abnormal for depression. The FACIT-Pal mean score was 129 (standard deviation 23), with emotional and functional well-being domains contributing most to poor quality of life. Seventy-one percent were frail. Patients with a nonischemic etiology had a 3.32 times higher rate of anxiety than nonischemic patients (95% confidence interval = 1.05-10.54, = 0.041). As patients undergoing transplant evaluation have high levels of depression, anxiety, and frailty, interdisciplinary care teams will be needed to properly manage the needs of this complex population. These results can inform efforts to integrate palliative care into advanced cardiac therapy and improve patients' experiences.
接受高级心脏治疗评估的患者的特征在很大程度上是未知的。为了描述在一家门诊心脏姑息治疗诊所接受高级治疗评估时患者的人口统计学特征、基线生活质量和脆弱性，并检查患者之间关键生活质量差异。回顾性图表审查以报告基线人口统计学和生活质量。美国一家大型学术医疗中心的患者，在 2021 年因高级心脏治疗而被转诊。使用医院焦虑和抑郁量表测量抑郁和焦虑；使用慢性病治疗-姑息治疗功能评估工具（FACIT-Pal）测量生活质量；使用弗里德脆弱性表测量脆弱性。根据疾病病因、人口统计学特征和脆弱性评估生活质量的差异。54 名患者在门诊心脏姑息治疗诊所接受高级治疗评估。大多数是白人（80%）和男性（74%）。患者平均前往诊所 61 分钟。除了五人之外，所有人都居住在农村、医疗服务不足或卫生专业人员短缺地区。40%的人焦虑评分异常或边缘异常；22%的人抑郁评分异常或边缘异常。FACIT-Pal 平均得分为 129（标准差 23），情感和功能健康领域对生活质量的影响最大。71%的人脆弱。非缺血性病因的患者焦虑发生率是缺血性患者的 3.32 倍（95%置信区间 1.05-10.54，=0.041）。接受移植评估的患者有较高的抑郁、焦虑和脆弱性水平，需要跨学科护理团队来妥善管理这一复杂人群的需求。这些结果可以为将姑息治疗纳入高级心脏治疗并改善患者体验提供信息。
