Department of Oncology and Palliative Care (C.L, G.I.J, S.L, L.V.H), North Zealand Hospital, Hillerød, Denmark; Section of Palliative Medicine (C.L, P.S, G.P.K, I.E, A-D.Z), Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology (B.J, S.L, N.T), North Zealand Hospital, Hillerød, Denmark.
J Pain Symptom Manage. 2024 Dec;68(6):561-572. doi: 10.1016/j.jpainsymman.2024.09.002. Epub 2024 Sep 11.
Heart failure (HF) is considered a multifaceted and life-threatening syndrome characterized by high symptom-burden and significant mortality.
To describe the symptom-burden in patients with HF and identify their palliative care needs. In this respect, symptom burden related to sex, age and classification of HF using New York Heart Association Functional Classification (NYHA) were analyzed.
A cross-sectional questionnaire survey included adult HF patients according to NYHA II, III, and IV. Palliative care needs were assessed using validated patient reported outcomes measures; SF-36v1, HeartQoL, EORTC- QLQ-C15-PAL, MFI-20 and HADS. Patients were recruited from the Department of Cardiology, North Zealand Hospital, Denmark.
In total, 314 patients (79%) completed the questionnaire (233 men). Mean age = 74 years (range 35-94 years). In all, 42% had NYHA III or IV and 53% self-rated their health to be fair or poor. In all, 19% NYHA II and 67% NYHA III/IV patients had ≥4 severe palliative symptoms according to EORTC-QLQ-C15-PAL. In addition, NYHA III/IV had a mean of 8.9 symptoms and a mean of 5.4 severe symptoms. Women, older patients, and those with NYHA III/IV had worse outcomes regarding health-related quality of life, functional capacity, and symptom burden.
Patients with HF have a high prevalence of symptoms and, thus, potential palliative care needs. Predominantly, women, older patients, and those with higher severity of disease have the highest symptom burden. PROMs can help cardiologists address the palliative care needs and systematic assessment may be a prerequisite to integrate symptom-modifying and palliative care interventions.
心力衰竭（HF）被认为是一种多方面的、危及生命的综合征，其特点是高症状负担和显著的死亡率。
描述 HF 患者的症状负担，并确定其姑息治疗需求。在这方面，分析了与性别、年龄和纽约心脏协会功能分类（NYHA）心力衰竭分类相关的症状负担。
一项横断面问卷调查包括根据 NYHA II、III 和 IV 分类的成年 HF 患者。使用经过验证的患者报告结局测量工具评估姑息治疗需求；SF-36v1、HeartQoL、EORTC-QLQ-C15-PAL、MFI-20 和 HADS。患者从丹麦北日德兰医院心内科招募。
共有 314 名患者（79%）完成了问卷（233 名男性）。平均年龄为 74 岁（范围 35-94 岁）。共有 42%的患者 NYHA III 或 IV 级，53%的患者自我报告健康状况为一般或较差。共有 19%的 NYHA II 级和 67%的 NYHA III/IV 级患者根据 EORTC-QLQ-C15-PAL 报告有≥4 种严重姑息症状。此外，NYHA III/IV 级患者的平均症状数为 8.9 个，严重症状数为 5.4 个。女性、年龄较大的患者和 NYHA III/IV 级患者在健康相关生活质量、功能能力和症状负担方面的结局更差。
HF 患者的症状发生率较高，因此存在姑息治疗需求。主要是女性、年龄较大的患者和疾病严重程度较高的患者的症状负担最高。PROMs 可以帮助心脏病专家解决姑息治疗需求，系统评估可能是整合症状改善和姑息治疗干预措施的前提。
