Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Department of Nursing, Georgetown University School of Nursing, Washington, DC, USA.
J Palliat Med. 2024 Aug;27(8):1026-1032. doi: 10.1089/jpm.2023.0670. Epub 2024 Apr 1.
The use of continuous intravenous inotropic support (CIIS) as palliative therapy in patients with advanced heart failure (HF) has increased over the past decade. CIIS improves New York Heart Association (NYHA) functional class but does not impact survival. The objective of this study was to examine patients' understanding of the therapeutic intent of CIIS, prognostic awareness, and quality of life with CIIS. We conducted a prospective, cross-sectional, multicenter study of patients with advanced HF receiving CIIS as palliative therapy between 2020 and 2022. An investigator-developed survey instrument was administered to outpatients on CIIS in the United States via telephone. Survey data were analyzed using descriptive and inferential statistics. Forty-eight patients, 63% male, 81% African American/Black, with a mean age of 68.9 (standard deviation 12.3) years, participated in this study. The majority of patients responded that they expected CIIS to make them feel better (79%) and increase longevity (75%), but few expected that CIIS would cure their HF (19%). Patients described their overall quality of life on CIIS as not better/worse (19%), somewhat better (46%), and significantly better (35%) and reported high treatment satisfaction (87% were at least somewhat satisfied). In this study, patients report improved quality of life with CIIS as palliative therapy. Patients on CIIS as palliative therapy expected increased survival on CIIS, which is incongruent with current evidence. Further studies on how we can improve care processes so that patients have accurate prognostic and disease-state awareness, and receive goal concordant care, are warranted.
在过去十年中，连续静脉内正性肌力支持（CIIS）作为晚期心力衰竭（HF）患者的姑息治疗的应用有所增加。CIIS 可改善纽约心脏协会（NYHA）功能分级，但不影响生存率。本研究旨在探讨患者对 CIIS 的治疗意图、预后意识以及 CIIS 治疗的生活质量的理解。我们进行了一项前瞻性、横断面、多中心研究，纳入了 2020 年至 2022 年间接受 CIIS 作为姑息治疗的晚期 HF 患者。通过电话在美国对接受 CIIS 治疗的门诊患者使用研究者开发的调查工具进行调查。使用描述性和推断性统计分析调查数据。本研究共纳入 48 例患者，其中 63%为男性，81%为非裔美国人/黑人，平均年龄为 68.9（标准差 12.3）岁。大多数患者表示他们期望 CIIS 能让他们感觉更好（79%）和延长寿命（75%），但很少有患者期望 CIIS 能治愈他们的 HF（19%）。患者描述他们在 CIIS 治疗期间的整体生活质量为没有更好/更差（19%）、略有改善（46%）和显著改善（35%），并报告了较高的治疗满意度（87%的患者至少有一些满意）。在这项研究中，患者报告 CIIS 作为姑息治疗可改善生活质量。接受 CIIS 姑息治疗的患者期望在 CIIS 上获得更长的生存时间，这与当前的证据不一致。进一步研究如何改善护理流程，使患者具有准确的预后和疾病状态意识，并获得与目标一致的护理，是必要的。
