Sivanathan Vithoosharan, Smallwood Natasha, Zentner Dominica
Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2025 Jul;55(7):1098-1104. doi: 10.1111/imj.70077. Epub 2025 Apr 28.
Women with chronic heart failure (CHF) experience an increased symptom burden, activity impairment and frailty. Although receiving palliative care services has been shown to improve the quality of life of people with CHF, few patients access this in a timely manner.
Explore whether there were differences in either referral to specialist palliative care or provision of elements of palliative care to women and men with CHF during their terminal admission in Australia.
This is a retrospective review of medical records for all admissions resulting in death from chronic heart failure (July 2011 to December 2019).
The cohort (n = 439) was elderly (median age 83.7 years, IQR = 77.6-88.7) and composed of 199 (45.1%) women. There was no association between sex and receiving an inpatient referral to specialist palliative care (P = 0.80). Women were less likely to receive life-sustaining interventions (intubation, inotropes, resuscitation, ICU stay) (odds ratio [OR] = 1.71, 1.04-2.83; P = 0.04) compared to men. Women were more likely to receive terminal symptom-related management (opioids or benzodiazepines) (OR = 3.19, 1.54-6.63; P = 0.01) or a palliative approach (OR = 1.68, 1.14-2.45; P < 0.01). Women were less likely to present to the emergency department (OR = 0.50, 0.31-0.79; P = 0.04) or be referred to an outpatient chronic disease programme (OR = 0.58, 0.34-0.98; P = 0.04) in the 12 months prior to death compared to men.
Given accepted differences in the timeliness of cardiac care for women, the apparent finding of better end-of-life care for women is intriguing and merits further research.
慢性心力衰竭（CHF）女性患者的症状负担、活动障碍和身体虚弱情况有所增加。尽管接受姑息治疗服务已被证明可改善CHF患者的生活质量，但很少有患者能及时获得此类服务。
探讨在澳大利亚，终末期住院期间，CHF女性和男性在转介至专科姑息治疗或接受姑息治疗要素方面是否存在差异。
这是一项对所有因慢性心力衰竭导致死亡的住院病例（2011年7月至2019年12月）的医疗记录进行的回顾性研究。
该队列（n = 439）为老年患者（中位年龄83.7岁，四分位间距 = 77.6 - 88.7），其中199名（45.1%）为女性。性别与接受住院转介至专科姑息治疗之间无关联（P = 0.80）。与男性相比，女性接受维持生命干预措施（插管、使用血管活性药物、复苏、入住重症监护病房）的可能性较小（比值比[OR] = 1.71，1.04 - 2.83；P = 0.04）。女性更有可能接受终末期症状相关管理（使用阿片类药物或苯二氮䓬类药物）（OR = 3.19，1.54 - 6.63；P = 0.01）或姑息治疗方法（OR = 1.68，1.14 - 2.45；P < 0.01）。与男性相比，女性在死亡前12个月内前往急诊科就诊的可能性较小（OR = 0.50，0.31 - 0.79；P = 0.04）或被转介至门诊慢性病项目的可能性较小（OR = 0.58，0.34 - 0.98；P = 0.04）。
鉴于公认的女性心脏护理及时性差异，女性在临终关怀方面表现更好这一明显发现很有趣，值得进一步研究。
