Comprehensive care for mechanical circulatory support: a new frontier for synergy with palliative care.
Comprehensive care for mechanical circulatory support: a new frontier for synergy with palliative care.
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DOI：
10.1161/circheartfailure.110.957241
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发表时间：
2011-07
期刊：
影响因子：
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通讯作者：
Meier DE
中科院分区：
文献类型：
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作者：
Goldstein NE;May CW;Meier DE
心力衰竭（HF）是一种慢性进行性疾病，在美国是导致死亡的主要原因。终末期心衰患者的治疗选择有限，因此机械循环支持（MCS）越来越多地被用于治疗终末期心衰患者。在2006年6月至2010年6月期间，美国2680名成年人接受了食品和药物管理局批准的耐用MCS设备作为终末期心衰的治疗。1大约82%接受MCS的患者在植入时被列入移植名单（移植桥，BTT）或至少有中等概率在MCS期间的某一时刻被列入移植名单（候选桥），而11%的患者将植入作为目的地治疗（DT）。目前，超过98%的植入耐用MCS装置的患者接受了连续血流左心室辅助装置。MCS的持续时间和生存受到许多因素的影响，包括植入时间、植入时的支持策略、患者的年龄和医疗合并症。在INTERMACS[机构间机械辅助循环支持登记]登记中，87%的BTT患者已经移植或在MCS上存活了12个月，而DT患者的这一比例为67%。通过对设备类型进行分层，考虑到2008年开始向连续血流泵的转变，所有接受原发性连续血流左室辅助装置的患者的12个月和24个月精算生存率分别为83%和75%，而DT患者的12个月精算生存率为74%。在过去2年中，连续流MCS支持的患者的结果数据有限。越来越多的心衰末期患者，稳定但数量不足的可用供体器官，以及MCS技术的持续改进，这些因素结合在一起，预测越来越多的患者将在这些设备上活得更长。患者及其护理人员在MCS上管理慢性疾病时面临的挑战特征不佳。虽然生活质量评分、纽约心脏协会功能分级和6分钟步行距离在左心室辅助装置植入后得到改善，但对MCS对患者的长期心理社会影响知之甚少
Heart Failure (HF) is a chronic and progressive illness and is a leading cause of death in the United States. Patients with end-stage HF have limited therapeutic options and thus mechanical circulatory support (MCS) is increasingly being used to treat patients with end-stage disease. Between June 2006 and June 2010, 2680 adults in the United States received a Food and Drug Administration–approved durable MCS device as treatment for end-stage HF. 1 Roughly 82% of patients receiving MCS were either listed for transplant at time of implant (bridge to transplant, BTT) or had at least a moderate probability of being listed for transplant at some point during MCS (bridge to candidacy), whereas 11% were implanted as destination therapy (DT). Currently, more than 98% of patients implanted with a durable MCS device receive a continuous-flow left ventricular assist device. 1 The duration of MCS and survival is influenced by a number of factors, including timing of implant, strategy of support at time of implant, age of patient, and medical comorbidities. Within the INTERMACS [Interagency Registry for Mechanically Assisted Circulatory Support] registry, 87% of BTT patients have been transplanted or are still alive on MCS at 12 months compared with 67% of DT patients. By stratifying by type of device to account for the shift to continuous flow pumps that began in 2008, 12-and 24-month actuarial survival for all patients receiving a primary continuous-flow left ventricular assist device as BTT is 83% and 75%, respectively, whereas 12-month actuarial survival for DT patients is 74%. Outcome data on patients supported by continuous-flow MCS past 2 years are limited.The combination of the increasing number of patients reaching the end stages of HF, the stable but inadequate number of available donor organs, and the continued improvements in MCS technology predicts that an increasing number of patients will be living longer on these devices. The challenges faced by patients and their caregivers in managing chronic illness on MCS are poorly characterized. Although quality-of-life scores, New York Heart Association functional class, and distance walked in 6 minutes are improved after left ventricular assist device implant, 2, 3 little is known about the long-term psychosocial impact of MCS on patients and