Saito Shunsuke, Yoshioka Daisuke, Kawamura Takuji, Kawamura Ai, Misumi Yusuke, Akazawa Yasuhiro, Sera Fusako, Kubota Kaori, Yamauchi Takashi, Sakata Yasushi, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
J Artif Organs. 2025 Jun;28(2):192-197. doi: 10.1007/s10047-024-01463-x. Epub 2024 Aug 7.
We examined the number of patients abandoning cardiac replacement therapy due to the inability to secure a designated caregiver. At Osaka University Hospital Heart Center, when we receive a consultation for a patient with severe heart failure from another hospital, a heart failure team makes a visit to the referring hospital as soon as possible. We retrospectively analyzed this hospital-visit database. We received 199 severe heart failure consultations from 2016-2023. Issues identified during hospital visits included age ≥ 65 years (8%), inability to confirm the patient's intention (8.5%), and explicit refusal of therapy (2.5%). Medical problems included multiple organ failure (18.1%), obesity (13.1%), diabetes (9.5%), malignancy (5.5%), chronic dialysis (1.0%), and other systemic diseases (12.6%). Adherence problems included poor medication compliance (3.5%), history of heavy drinking (2.5%), and smoking (2.0%). Social problems included inadequate family support in 16.1% of patients. Of the 199 patients, 95 (48.0%) proceeded to a heart transplant and LVAD indication review meeting at Osaka University Hospital. The remaining 104 patients (52.0%) did not proceed to the meeting. Reasons included improvement of heart failure with conservative treatment in 37 cases (35.6%), death before discussion in 21 cases (20.2%), medical contraindications in 18 cases (18.3%), lack of caregivers in 18 cases (18.3%; 9.5% of 199 cases), and patient refusal in 5 cases (4.8%). Approximately 10% of patients consulted at Osaka University Hospital Heart Center for severe heart failure abandoned cardiac replacement therapy due to the lack of caregivers.
我们调查了因无法确保有指定护理人员而放弃心脏替代治疗的患者数量。在大阪大学医院心脏中心，当我们收到来自其他医院的严重心力衰竭患者的会诊请求时，心力衰竭团队会尽快前往转诊医院。我们对这个医院访视数据库进行了回顾性分析。我们在2016年至2023年期间收到了199例严重心力衰竭会诊请求。医院访视期间发现的问题包括年龄≥65岁（8%）、无法确认患者意愿（8.5%）以及明确拒绝治疗（2.5%）。医疗问题包括多器官衰竭（18.1%）、肥胖（13.1%）、糖尿病（9.5%）、恶性肿瘤（5.5%）、慢性透析（1.0%）以及其他全身性疾病（12.6%）。依从性问题包括用药依从性差（3.5%）、酗酒史（2.5%）和吸烟（2.0%）。社会问题包括16.1%的患者家庭支持不足。在这199例患者中，95例（48.0%）前往大阪大学医院参加了心脏移植和左心室辅助装置适应症审查会议。其余104例患者（52.0%）未参加会议。原因包括37例（35.6%）经保守治疗心力衰竭得到改善、21例（20.2%）在讨论前死亡、18例（18.3%）存在医疗禁忌、18例（18.3%；占199例的9.5%）缺乏护理人员以及5例（4.8%）患者拒绝。在大阪大学医院心脏中心因严重心力衰竭接受会诊的患者中，约10%因缺乏护理人员而放弃了心脏替代治疗。
