RAPHAEL - Integrating a Palliative Care Approach for Patients with Heart Failure

虽然将姑息治疗（PC）服务整合到心力衰竭（HF）治疗中的必要性已得到充分认识，但迄今为止，这种整合还远远落后，特别是与癌症治疗相比。目前，只有5-7%的心衰患者利用PC服务，原因是专注于优化治疗，而且疾病发展轨迹难以预测，病情恶化会影响预后。因此，许多与心衰没有直接关系的症状和担忧未被识别和治疗不足，患者通常在生命的最后才被转介到PC服务。RAPHAEL联盟计划通过将theRAPHAEL姑息治疗方法整合到现有的心衰治疗途径中，将PC整合到心衰治疗中，从而迈出下一步。这种灵活和以患者为中心的方法首先确定多方面的症状和关切，优先考虑患者和非正式护理人员的需求，并制定积极的护理计划。患者将在家中使用PAL@HEART应用程序监测症状和担忧。该应用程序可用于评估干预措施，支持沟通，并识别新的或不断增长的需求。因此，每位心衰患者的护理需求得到更快、更好的解决，提高了他们的生活质量和自主性。此外，这将减少紧急住院治疗，减轻医疗保健系统的负担，降低成本。RAPHAEL项目着手在欧洲范围内将RAPHAEL方法应用于心衰护理，并通过在7个欧盟国家、英国和瑞士进行的可行性和大规模评估研究来测试和验证其（成本）效益。它汇集了姑息治疗、心脏病学和初级保健方面的专家以及专业组织和患者代表。RAPHAEL联盟在展示RAPAHEL方法的（成本）效益方面具有独特的地位，并在欧洲及其他地区实施。

While the need for integrating palliative care (PC) services into heart failure (HF) care has been well recognised, as of yet this integrationlacks behind, especially when compared to cancer care. Currently, only 5-7% of patients with HF utilise PC services, due to a focus onoptimising therapy and an unpredictable disease trajectory with exacerbations which hampers prognosis. As a result, many symptomsand concerns that are not directly related to HF are not recognised and undertreated and patients are often referred to PC services only atthe very end of their lives. The RAPHAEL consortium sets out to take the next big step in integrating PC into HF care by integrating theRAPHAEL palliative care approach in existing HF care pathways. This flexible and patient centred approach starts with the identificationof multidimensional symptoms and concerns, prioritise needs with patient and informal carer and formulate a proactive care plan. Thesymptoms and concerns will be monitored by the patient at home using the PAL@HEART application. The app can be used to evaluateinterventions, support communication and earl identify new or increasing needs. As a result, the care needs of each individual patient withHF are addressed faster and better, improving their quality of life and autonomy. Moreover, this will lead to a reduction in emergencyhospitalisations, unburdening the healthcare system and reducing costs. The RAPHAEL project sets out to adapt the RAPHAEL approachto HF care within a European context and test and validate its (cost-)effectiveness via a feasibility and large-scale evaluation studyperformed in 7 EU countries, the UK and Switzerland. It brings together experts in palliative care, cardiology, and primary care as wellas professional organisations and patient representatives. Together the RAPHAEL consortium is uniquely situated to demonstrate the(cost-)effectiveness of the RAPAHEL approach and launch its implementation in Europe and beyond.