The state of palliative care and heart failure.
The state of palliative care and heart failure.
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姑息治疗和心力衰竭的状态。
DOI：
10.1016/j.hrtlng.2012.09.003
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Hupcey,JudithE
中科院分区：
文献类型：
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作者：
Hupcey,JudithE
据估计，超过660万18岁以上的美国人患有心力衰竭。心力衰竭导致的死亡率仍然很高，与15年前相比几乎没有变化; 5年死亡率仍然徘徊在50%左右。1尽管有这些令人震惊的数字，但对心力衰竭患者的支持服务仍然不成比例地低。服务，如姑息治疗和临终关怀，已被推荐，以满足整个生命末期心力衰竭轨迹的病人-照顾者二人组的复杂需求。尽管根据CDC最新的统计数据，自2000年以来，终末期HF患者转诊至临终关怀的百分比显著增加，但心脏病仅占临终关怀入院人数的11%，其中6.4%为心力衰竭。对于其他服务，包括旨在促进，恢复和维持健康的广泛医疗和治疗服务，目标是最大限度地提高患者的独立性，只有4.3%的入院是心力衰竭。2这些服务（可归类为姑息治疗）将护理扩展到传统医学模式对患者生理症状的关注之外，还可能包括患者及其家庭护理人员的精神需求，情感健康，决策，损失，悲伤和应对。3十多年来，人们已经认识到心力衰竭需要姑息治疗。最初，这被概念化为一条服务线或指定团队，类似于临终关怀，将在疾病的终末期提供。最近，姑息治疗的目标已经扩大，模型已经发展，设想姑息治疗作为一种护理理念，提供给所有心力衰竭患者沿着其他治疗，从最初的诊断到生命结束。4作为一种理念，所有照顾病人和家属的医疗保健提供者都将提供这些服务的一部分，或者根据需要介绍病人-照顾者二人组。这也包括在生命轨迹的最后阶段转诊到临终关怀医院。因此，姑息治疗的目标是在心力衰竭的整个过程中改善患者及其家属的生活质量，无论是慢性疾病过程还是更快速的终末轨迹。3
It is estimated that over 6.6 million Americans over the age of 18 have heart failure. Deaths attributed to heart failure remain high and the numbers are virtually unchanged from 15 years ago; with the 5-year mortality rate still hovering around 50%. 1 Despite these alarming numbers, support services for heart failure patients continue to remain disproportionately low. Services, such as palliative care and hospice, have been recommended to meet the complex needs of patient–caregiver dyads throughout the end-of-life heart failure trajectory. Although the percent of end-stage HF patients referred to hospice has significantly increased since 2000 according to the most recent CDC statistics, 2 heart disease accounted for only 11% of hospice admissions with 6.4% for heart failure. For other services, which include a wide range of medical and therapeutic services aimed at promoting, restoring, maintaining health with the goal of maximizing the level of independence for a patient, only 4.3% of admissions were for heart failure. 2 These services (which can be classified as palliative care) extend care beyond the traditional medical model’s focus on patients’ physiologic symptoms but also may include spiritual needs, emotional health, decision-making, loss, grief, and coping for both patients and their family caregivers. 3For over a decade, the need for palliative care for heart failure has been recognized. Initially, this was conceptualized as a service line or designated team, similar to hospice, which would be offered in the terminal phase of the disease. More recently, the goals of palliative care have been expanded and the models have evolved that envision palliative care as a philosophy of care delivered to all heart failure patients along with other treatments from initial diagnosis to end of life. 4 As a philosophy, all healthcare providers who care for the patient and family would provide pieces of these services or refer the patient–caregiver dyad, as needed. This would also include referrals to hospice during the terminal phase of the trajectory. Thus, the goal of palliative care is to improve quality of life for both patients and their families throughout the course of heart failure, whether it follows a chronic disease course or a more rapid terminal trajectory. 3