Pilot Study of Palliative Care Consultation in Patients with Advanced Heart Failure Referred for Cardiac Transplantation
Pilot Study of Palliative Care Consultation in Patients with Advanced Heart Failure Referred for Cardiac Transplantation
复制标题
DOI：
10.1089/jpm.2011.0256
复制
发表时间：
2012-01-01
影响因子：
2.8
通讯作者：
Bharadwaj, Parag
中科院分区：
文献类型：
--
作者：
Schwarz, Ernst R.;Baraghoush, Afshan;Bharadwaj, Parag
背景：慢性心力衰竭是一种不可逆转的进展性疾病。姑息治疗(PC)干预传统上侧重于晚期癌症患者。我们进行了一项试点研究，以评估美国心脏病学会/美国心脏协会(ACC/AHA)指南对正在寻求或接受潜在治疗的晚期心力衰竭患者进行早期PC干预的可行性。方法：连续20名因心脏移植服务而转诊为PC的晚期心力衰竭患者，纽约心脏协会(NYHA)III-IV级症状在三级护理环境中进行了回顾分析。回顾数据以评估PC干预的临床影响。获得反馈，以评估患者、他们的家人和卫生保健专业人员的满意度。心脏病专家和PC内科医生使用评分系统对PC服务在每个患者的护理中的影响进行了独立评估。结果：连续20名心力衰竭患者被分析。获得PC咨询的原因有很多。所有患者都抱怨症状负担很大。PC会诊导致阿片类药物的使用减少，患者满意度提高。患者及其家属普遍报告改善了整体护理、护理的连续性、更有针对性的护理目标以及改善了治疗过程的规划。用于确定PC服务影响的非标准化评分系统在心脏病专家和PC医生的评估中显示出平均中等到显著的影响。结论：PC会诊对晚期心力衰竭患者的治疗和生活质量似乎是有益的，与他们的预后无关。这项先导性研究证明了临床益处的可行性和充分证据，证明有必要进行一项更大规模的随机临床试验，评估PC在晚期心力衰竭患者中应用标准介入的益处，而与患者的预后或治疗目标无关。
Background: Heart failure (HF) in its chronic form is an irreversible and progressive disease. Palliative care (PC) interventions have traditionally been focused on patients with advanced cancer. We performed a pilot study to assess the feasibility of implementing the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for early PC intervention in patients with advanced HF who were seeking or received potentially curative therapies.Methods: Twenty consecutive patients with advanced HF referred to PC from the heart transplant service with stage D, New York Heart Association (NYHA) class III-IV symptoms were analyzed retrospectively in a tertiary care setting. Data were reviewed to assess the clinical impact of PC intervention. Feedback was obtained to assess satisfaction of the patients, their families, and the health care professionals. An independent assessment of the impact of the PC service in the care of each patient was performed by a cardiologist and PC physician by use of a scoring system.Results: Twenty consecutive patients with HF were analyzed. PC consult was obtained for a variety of reasons. All patients complained of a high symptom burden. PC consultation resulted in a decrease in the use of opioids and increased patient satisfaction. Patients and their family members generally reported improved holistic care, continuity of care, more focused goals of care, and improved planning of treatment courses. The nonstandardized scoring system used to determine the impact of the PC service showed an average of moderate to significant impact when assessed by both a cardiologist and a PC physician.Conclusion: PC consultation appears to be beneficial in the treatment and quality of life of advanced HF patients, independent of their prognosis. This pilot study demonstrated feasibility and sufficient evidence of clinical benefit to warrant a larger randomized clinical trial assessing the benefit of standard involvement by PC in patients with advanced HF, independent of the patient's prognosis or treatment goals.