Nadarajah Shamara, Sirianni Giovanna, Poon Stephanie, Bonares Michael
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Palliative Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2024 Oct 29. doi: 10.1136/spcare-2024-005193.
People with heart failure have palliative care needs yet services remain underused. The heart failure clinic is a potential setting for initial palliative care delivery though evidence for such services is lacking. We explored the outcomes of an embedded model of palliative medicine within a heart failure clinic.
We conducted a retrospective cohort study of individuals who received a palliative medicine consultation in a heart failure clinic. Descriptive statistics were used to characterise the cohort and their outcomes, and the McNemar test to compare rates of advance care planning before/after consultation.
Majority of individuals who received a palliative medicine consultation experienced New York Heart Association (NYHA) class II symptoms (65.5%) and had a Palliative Performance Scale score of≥60% (66.8%). While only 17% engaged in advance care planning in the year before consultation, 93% had advance care planning during the first consultation (p<0.001). Care was provided in multiple domains including advance care planning (95%), symptom management (97%) and caregiver support (30%), regardless of the reason for referral.
Our embedded model of palliative medicine within the heart failure clinic was associated with increased advance care planning at a time when patients were functional and minimally symptomatic. Further research should substantiate these findings at other sites.
心力衰竭患者有姑息治疗需求，但服务仍未得到充分利用。心力衰竭诊所是提供初始姑息治疗的潜在场所，不过此类服务的证据尚缺。我们探讨了在心力衰竭诊所内采用姑息医学嵌入式模式的效果。
我们对在心力衰竭诊所接受姑息医学会诊的个体进行了一项回顾性队列研究。使用描述性统计来描述该队列及其结果，并采用McNemar检验比较会诊前后的预立医疗计划率。
接受姑息医学会诊的大多数个体有纽约心脏协会（NYHA）II级症状（65.5%），且姑息治疗表现量表评分≥60%（66.8%）。虽然会诊前一年只有17%的人参与了预立医疗计划，但93%的人在首次会诊时进行了预立医疗计划（p<0.001）。无论转诊原因如何，在多个领域提供了护理，包括预立医疗计划（95%）、症状管理（97%）和照顾者支持（30%）。
我们在心力衰竭诊所采用的姑息医学嵌入式模式与患者功能尚好且症状轻微时预立医疗计划的增加有关。进一步的研究应在其他场所证实这些发现。
