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Ali S, Tyerman J. Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis. Am J Hosp Palliat Care 2024; 41:1061-1075. [PMID: 37963548 PMCID: PMC11318222 DOI: 10.1177/10499091231213606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. OBJECTIVE This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. DESIGN The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. RESULTS The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. CONCLUSION Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.
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Affiliation(s)
- Sana Ali
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
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2
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Trullàs JC, Moreno-García MC, Mittelbrunn-Alquézar V, Conde-Martel A, Soler-Rangel L, Montero-Pérez-Barquero M, Casado J, Sánchez-Marteles M, Arévalo-Lorido JC, Pérez-Silvestre J. The RICA-2 registry: design and baseline characteristics of the first 1,000 patients. Rev Clin Esp 2024:S2254-8874(24)00102-4. [PMID: 39053884 DOI: 10.1016/j.rceng.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry. METHODS Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with de novo HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities. RESULTS RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition. CONCLUSION The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine.
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Affiliation(s)
- J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i Comarcal de La Garrotxa, Girona, Catalonia, Spain; Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de La Vida i de La Salut a La Catalunya Central (IrisCC), Barcelona, Spain.
| | | | | | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - L Soler-Rangel
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
| | | | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain
| | - M Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
| | - J Pérez-Silvestre
- UMIPIC, Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Takahama H, Kitai T, Nakagawa S, Takegami M, Hamatani Y, Nakamoto K, Ohtani T, Yamamoto J, Shintani Y, Anchi Y, Azechi M, Kawano Y, Takada Y, Yumino D, Seo Y, Sakata Y, Akao M, Yasuda S, Nishimura K, Izumi C. Rationale and Design of a Multicenter Trial on Exploratory Analysis of the Effects of Advance Care Planning Guided by the Prediction Program of Heart Failure Prognosis on Quality of Life in Patients With Heart Failure - ACQUAINT-Trial. Circ Rep 2024; 6:276-280. [PMID: 38989104 PMCID: PMC11233169 DOI: 10.1253/circrep.cr-24-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/12/2024] Open
Abstract
Background: Preplanning of care is necessary for patients with endstage heart failure (HF), but advance care planning (ACP) before the loss of a patient's comprehensive capacity is not yet routine for the public or the medical community. The challenge in accurately predicting a patient's prognosis is a strong barrier to implementing ACP. To address this problem, several models for risk stratification have been proposed and are available in clinical settings. Methods and Results: We randomized the procedure to provide estimated patient survival information to attending physicians and then assessed whether there was a change in (1) the frequency of ACP initiation occurred (physician-side evaluation), and/or (2) the patients' quality of life, including mental state (patient-side evaluation). Conclusions: This multicenter, open-label, single-blinded randomized clinical trial aims to assess the hypothesis that providing information on the estimated survival of a patient to the attending physicians will improve the frequency of ACP initiation and quality of life in patients with HF.
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Affiliation(s)
- Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Shoko Nakagawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
- Department of Public Health and Health Policy, School of Medicine, The University of Tokyo Tokyo Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kei Nakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medicine Nagoya Japan
| | - Yasuhiro Shintani
- Department of Cardiology, Nagoya City University Graduate School of Medicine Nagoya Japan
| | - Yuta Anchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Michiyo Azechi
- Department of Psychiatry, National Cerebral and Cardiovascular Center Suita Japan
| | - Yukie Kawano
- Department of Nursing, National Cerebral and Cardiovascular Center Suita Japan
| | - Yasuko Takada
- Department of Nursing, National Cerebral and Cardiovascular Center Suita Japan
| | | | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medicine Nagoya Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
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Contra A, Garcia L, Pons P, Formiga F. [Do patients with advanced heart failure know the characteristics and prognosis of their disease?]. Rev Esp Geriatr Gerontol 2024; 59:101456. [PMID: 38245994 DOI: 10.1016/j.regg.2023.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Anna Contra
- Servicio de Medicina Interna. Hospital Universitari de Bellvitge. IDIBELL. Universidad de Barcelona. L'Hospitalet de Llobregat, Barcelona, España.
| | - Lourdes Garcia
- Servicio de Medicina Interna. Hospital Universitari de Bellvitge. IDIBELL. Universidad de Barcelona. L'Hospitalet de Llobregat, Barcelona, España
| | - Paula Pons
- Servicio de Medicina Interna. Hospital Universitari de Bellvitge. IDIBELL. Universidad de Barcelona. L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Servicio de Medicina Interna. Hospital Universitari de Bellvitge. IDIBELL. Universidad de Barcelona. L'Hospitalet de Llobregat, Barcelona, España
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Salamanca-Bautista P, Romero-Correa M, Formiga F, Antequera-Martín-Portugués I, Llàcer P, Marrero-Medina IG, Calderón-Jiménez P, Moreno-Palanco MÁ, Armengou-Arxe A, Gonzalo-Pascua S, Piñeiro-Parga P, Aramburu-Bodas Ó. Safety of benzodiazepines in patients with acute heart failure: A propensity score-matching study. Int J Cardiol 2023; 382:40-45. [PMID: 37062342 DOI: 10.1016/j.ijcard.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/28/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
AIM Benzodiazepines (BZDs) are one of the most used drugs to control symptoms in patients with acute heart failure (HF). However, the evidence on its safety is inconclusive. The objective was to describe the characteristics of patients admitted for HF and treated with BZDs and to assess the relationship of this treatment and mortality. PATIENTS AND METHODS We performed a cross-sectional, multicentre (74 Spanish hospitals), cohort study. Patients admitted for HF were divided depending on whether they were treated with BZDs or not. Propensity score analysis matched patients in both groups in a 1:1 manner according to different factors. The primary outcome was mortality at day 7. Secondary outcomes were mortality at days 30 and 180, as well as readmissions and emergency room visits at 180 days. RESULTS We included 1855 patients: 639 (34.4%) had prescribed BZDs treatment versus 1216 (65.6%) who had not been treated. Patients receiving BZDs had advanced heart disease, severe symptoms, need more HF intensive treatment and higher mortality. After propensity matching 381 balanced paired cases were included in each group. Treatment with BZDs was not associated with greater risk of mortality at day 7 of index hospitalization (7.6% vs 5.2%, adjusted OR 1.49, 95% CI 0.83-2.68, p = 0.186). There were also no differences between groups in terms of mortality at day 30 and 180, readmissions or visits to the emergency room. CONCLUSIONS Our data support that benzodiazepines could be safely used for improving symptoms. in patients admitted for acute HF in terms of short-medium term mortality.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Deparment, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; Department of Medicine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain.
| | | | | | | | - Pau Llàcer
- Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | | | | | | | | | | | - Óscar Aramburu-Bodas
- Internal Medicine Deparment, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; Department of Medicine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain
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Zhang J, Li W, Xiao J, Hui J, Li Y. Prognostic significance of carbohydrate antigen 125 in stage D heart failure. BMC Cardiovasc Disord 2023; 23:108. [PMID: 36841766 PMCID: PMC9960178 DOI: 10.1186/s12872-023-03139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The predictive value of carbohydrate antigen 125 (CA125) has not been examined in stage D heart failure (HF) patients, regardless of left ventricular ejection fraction (LVEF). We sought to quantify the prognostic usefulness in predicting death and HF readmission in this cohort. METHODS According to CA125 levels above and below the median (65.7 U/ml), 176 stage D HF patients including more than half (50.6%) had LVEF > 40% were divided into 2 groups. RESULTS A total of 106 (60.2%) deaths and 102 deaths due to the cardiovascular disease were identified. All-cause death/HF readmission and MACE occurred in 157 patients (89.2%) during 18 months (16-20) of follow-up. By the Kaplan-Meier method, subjects with CA125 ≥ 65.7 U/ml exhibited higher 1-year mortality rate (59.3% vs. 31.0%, P < 0.001) and 1-year death/HF rehospitalization rate (94.2% vs. 80.6%, P < 0.001). In univariate Cox analysis, CA125 (categorized) was a significant prognostic factor for all-cause death, cardiovascular mortality, death/HF readmission and MACE. Based on multivariate Cox analysis, elevated CA125 was still significant for all-cause death, cardiovascular mortality, death/HF readmission and MACE. CONCLUSIONS In stage D HF patients, elevated CA125 levels were highly predictive of all-cause death, cardiovascular mortality, all-cause death/HF readmission and MACE, which can be used for better risk stratification.
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Affiliation(s)
- Ji Zhang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China.
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, No. 2, Yongning Road, Changzhou, Jiangsu Province, China
| | - Jie Hui
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Li
- School of Math and Statistics, Nanjing Audit University, Nanjing, China
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7
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Advanced Heart Failure in the Cardiac Intensive Care Unit: A Community-Based Study. JACC. HEART FAILURE 2023; 11:252-254. [PMID: 36754533 DOI: 10.1016/j.jchf.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 02/08/2023]
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8
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Ten Questions and Some Reflections about Palliative Care in Advanced Heart Failure Patients. J Clin Med 2022; 11:jcm11236933. [PMID: 36498508 PMCID: PMC9735532 DOI: 10.3390/jcm11236933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022] Open
Abstract
Heart failure is a clinical syndrome with increasing prevalence, high morbidity and mortality. It is characterized by high symptom burden, poor quality of life and high economic costs. This implies that the heart failure (HF) patients who receive palliative care (PC) have needs similar to cancer patients, but which are often unmet. This paper analyzes the main unresolved issues regarding the relationship between HF patients and the referral to an early PC program. These issues are presented as ten questions related to which patients should be admitted to PC and at what stage of their disease. Furthermore, the barriers opposing to referral to PC, the role of cardiologists and PC physicians within the care team, the gap between the scientific societies' suggestions and the real world, the right time to promote patients' awareness and shared decision making, regarding prognosis, end of life wishes and choices, with reference also to cardiac implantable devices' deactivation, are discussed. These unresolved questions support the need to reevaluate programs and specific models in achieving equal access to palliative care interventions for HF patients, which is still mainly offered to patients with cancer.
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Arévalo Lorido JC, Salamanca Bautista P, Formiga F, Méndez Bailón M, Aramburu Bodas Ó. Tackling Palliative Care in Advanced Heart Failure. J Am Coll Cardiol 2022; 80:e203-e204. [DOI: 10.1016/j.jacc.2022.08.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
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10
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Lorido JCA, Gómez JC, Correa MR, Iglesias JR, Fernández TC, Camajuncosa RJ, Izquierdo MC, Guardiola CJ, Pardo LF, Ruiz EP, Formiga F, Bautista PS. Different profiles of advanced heart failure among patients with and without diabetes mellitus. Findings from the EPICTER study. Eur J Intern Med 2022; 104:59-65. [PMID: 35879216 DOI: 10.1016/j.ejim.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 12/28/2022]
Abstract
AIM This work aims to compare the characteristics of advanced heart failure (HF) in patients with and without type 2 diabetes mellitus (DM) and to determine the relevance of variables used to define advanced HF. PATIENTS AND METHODS This cross-sectional, multicenter study included patients hospitalized for HF. They were classified into four groups according to presence/absence of advanced HF, determined based on general and cardiac criteria, and presence/absence of DM. To analyze the importance of variables, we grew a random forest algorithm (RF) based on mortality at six months. RESULTS A total of 3153 patients were included. The prevalence of advanced HF among patients with DM was 24% compared to 23% among those without DM (p=0.53). Patients with advanced HF and DM had more comorbidity related to cardiovascular and renal diseases; their prognosis was the poorest (log-rank <0.0001) though the adjusted hazard ratio by group in the Cox regression analysis was not significant. The variables that were significantly related to mortality were the number of comorbidities (p=0.005) and systolic blood pressure (p=0.024). The RF showed that general criteria were more important for defining advanced HF than cardiac criteria. CONCLUSIONS Patients with advanced HF and DM were characterized by DM in progression with macro and microvascular complications. The outcomes among advanced HF patients were poor; patients with advanced HF and DM had the poorest outcomes. General criteria were the most important to establish accurately a definition of advanced HF, being decisive the evidence of disease progression in patients with DM.
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Affiliation(s)
- José Carlos Arévalo Lorido
- Internal Medicine Department, Hospital Universitario de Badajoz, Avda de Elvas s/n, 06080, Badajoz. Spain.
| | - Juana Carretero Gómez
- Internal Medicine Department, Hospital Universitario de Badajoz, Avda de Elvas s/n, 06080, Badajoz. Spain
| | - Miriam Romero Correa
- Internal Medicine Department, Hospital de Rio Tinto, Av. de la Esquila, 5, 21660 Minas de Riotinto, Huelva
| | - Jesus Recio Iglesias
- Internal Medicine Department, Vithas Hospital Valencia 9 de Octubre, Carrer de la Vall de la Ballestera, 59, 46015, Valencia.
| | - Teresa Choucino Fernández
- Internal Medicine Department, Complejo Hospitalario Universitario de A Coruña, As Xubias, 84, 15006 A Coruña.
| | | | | | - Carlos Jiménez Guardiola
- Internal Medicine Department, Hospital de la Vega Baja, Carretera Orihuela-Almoradí, S/N BAJO San Bartolomé, 03314, Orihuela Alicante
| | - Lucía Fuentes Pardo
- Internal Medicine Department, Complejo Asistencial de Zamora, Av. de Requejo, 35, 49022 Zamora
| | - Esther Piniella Ruiz
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid. Carr. Madrid Toledo, Km 12,500, 28905 Getafe, Madrid
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona.
| | - Prado Salamanca Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Calle Dr. Fedriani, 3, 41009 Sevilla
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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12
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Aguilar-Fuerte M, Alonso-Ecenarro F, Broch-Petit A, Chover-Sierra E. Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit. Healthcare (Basel) 2022; 10:healthcare10091609. [PMID: 36141221 PMCID: PMC9498741 DOI: 10.3390/healthcare10091609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Heart failure (HF) is a chronic and complex pathology requiring continuous patient management due to clinical instability, associated comorbidity, and extensive pharmacological treatment. Its unpredictable course makes the advanced stages challenging to recognize and raises the need for palliative care. This study aims to identify palliative care needs in HF patients and describe clinical features related to short-term mortality. (2) Methods: A descriptive, observational, cross-sectional, and retrospective study was carried out in an HF unit of a Spanish tertiary hospital. Patients’ socio-demographic and clinical data were collected from clinical records, and different instruments were used to establish mortality risks and patients’ needs for palliative care. Subsequently, univariate and bivariate descriptive analyses were performed. A binary logistic regression model helped to determine variables that could influence mortality 12 months after admission to the Unit. (3) Results: The studied population, sixty-five percent women, had an average age of 83.27 years. Among other clinical characteristics predominated preserved ejection fraction (pEF) and dyspnea NYHA (New York Heart Association) class II. The most prevalent comorbidities were hypertension and coronary heart disease. Forty-nine percent had a low–intermediate mortality risk in the following year, according to the PROFUND index. The NECPAL CCOMS-ICO© instrument identified subjects who meet the criteria for palliative care. This predictive model identified NECPAL CCOMS-ICO© results, using beta-blockers (BB) or AIIRA (Angiotensin II receptor antagonists) and low glomerular filtration rate (GFR) as explanatory variables of patients’ mortality in the following year. (4) Conclusions: The analysis of the characteristics of the population with HF allows us to identify patients in need of palliative care. The NECPAL CCOMS-ICO© instrument and the PROFUND have helped identify the characteristics of people with HF who would benefit from palliative management.
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Affiliation(s)
- Marta Aguilar-Fuerte
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain
| | | | - Alejandro Broch-Petit
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 València, Spain
| | - Elena Chover-Sierra
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 València, Spain
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain
- Correspondence:
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Romero‐Correa M, Salamanca‐Bautista P, Bilbao‐González A, Quirós‐López R, Nieto‐Martín MD, Martín‐Jiménez ML, Morales‐Rull JL, Quiles‐García D, Gómez‐Gigirey A, Formiga F, Aramburu‐Bodas Ó, Arias‐Jiménez JL, Choucino‐Fernández T, Porto‐Pérez A, Piñeiro‐Parga P, Pedrosa‐Fraga C, Suárez‐Gil R, González‐Soler J, López‐Mato P, Latorre‐Díez A, Ferreira‐González L, Sánchez‐Cembellin M, Gallego‐Villalobos M, Rugeles‐Niño J, Rodríguez‐Avila E, González‐Franco A, Guerra‐Acebal C, Sebastián‐Leza A, Monte‐Armenteros J, Frutos‐Muñoyerro G, Clemente‐Sarasa C, Díez‐Manglano J, Josa‐Laorden C, Torres‐Courchoud I, Gómez‐Aguirre N, Jordana‐Camajuncosa R, Cajamarca‐Calva L, Torrente‐Jiménez I, Serrado‐Iglesias A, Ceresuela L, Salas‐Campos R, Delás‐Amat J, Brasé‐Arnau A, Petit‐Salas I, Romaní‐Costa V, Expósito‐López A, Sabbagh‐Fajardo C, Recio‐Iglesias J, Alemán‐Llansó C, Suriñach‐Caralt J, Trullás‐Vila J, Armengou‐Arxe A, García‐Torras S, Solé‐Felip C, Lacal‐Martínez A, Otero‐Soler M, Muela‐Molinero A, Carrera‐Izquierdo M, Arribas‐Arribas P, Inglada‐Galiana L, Ruiz ‐de Temiño Á, Silva‐Vázquez Á, Fuentes‐Pardo L, García‐García M, Piniella‐Ruiz E, Pérez‐Alves B, Gonzalo‐Pascua S, Marrero‐Francés J, Méndez‐Bailón M, Martín‐Sánchez F, Varas‐Mayoral M, Asenjo‐Martínez M, Yebra‐Yebra M, Sánchez‐Sauce B, Herreros B, Quesada‐Simón A, Vives‐Beltrán I, Álvarez‐Troncoso J, Martínez‐Marín L, Martínez PG, Mayorga ED, Moreno‐Palanco M, Soler‐Rangel L, Abellán‐Martínez J, Colás‐Herrera A, López‐Castellanos G, Ruíz‐Ortega R, Ruiz‐Barraza E, Montero‐Hernández E, Arévalo‐Lorido J, Carretero‐Gómez J, Calderón‐Jiménez P, Herrero‐Domingo A, Martín‐Barba S, Blázquez‐Encinar J, Jiménez‐Guardiola C, Cepeda‐Rodrigo J, Carrascosa‐García S, Llacer‐Iborra P, Moreno‐García M, Díez‐García L, Sánchez‐López P, Martínez‐Soriano M, Menor E, Montero‐Pérez‐Barquero M, Anguita‐Sánchez M, Sánchez‐Moruno M, Fuentes‐Espínola M, Zambrana‐García J, Guisado‐Espartero E, Mejías‐Real I, Alcalá‐Pedrajas J, Carrasco‐Sánchez F, Díaz‐Pérez C, Guzmán‐García M, Domingo‐Roa S, Cortés‐Rodríguez B, García‐Redecillas C, Martín‐Navarro R, Macías‐Ávila P, Antequera‐Martín‐Portugués I, Blanco‐Soto M, Flores‐Álvarez F, Aparicio‐Santos R, García‐Serrano R, Jiménez‐de‐Juan C, Ternero‐Vega J, Villalonga‐Comas M, Díaz‐Cañestro M, Asensio‐Rodríguez J, Gil‐Díaz A, Marrero‐Medina I, Puente‐Fernández A, Gudiño‐Aguirre D, Dávila‐Ramos M, Calderón E, Fernández‐Martínez J, Vázquez‐Rodríguez P, Conde‐Martel A, García‐García J, Páez‐Rubio I, López‐Reboiro M, Sánchez‐Sánchez C. The EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure. ESC Heart Fail 2022. [PMCID: PMC9288794 DOI: 10.1002/ehf2.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF. Methods and results A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow‐up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III–IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk). Conclusions The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy‐to‐use tool that could help to identify high‐risk patients requiring PC.
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Affiliation(s)
| | - Prado Salamanca‐Bautista
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
| | - Amaia Bilbao‐González
- Osakidetza Basque Health Service, Research Unit Basurto University Hospital Bilbao Spain
- Health Service Research Network on Chronic Diseases (REDISSEC) Barakaldo Spain
- Kronikgune Institute for Health Services Research Barakaldo Spain
| | | | | | | | | | - Dolores Quiles‐García
- Internal Medicine Department Hospital Universitario General de Valencia Valencia Spain
| | | | - Francesc Formiga
- Internal Medicine Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Óscar Aramburu‐Bodas
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
| | - José Luis Arias‐Jiménez
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
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Jardim PP, Cavalcanti ACD, Borges AS, Flores PVP, Rosa CA. Sinais e sintomas de pacientes com insuficiência cardíaca em cuidados paliativos: revisão de escopo. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2022-0064pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo Mapear a produção de conhecimento acerca dos sinais e sintomas de pacientes com insuficiência cardíaca em cuidados paliativos. Método Revisão de escopo conduzida de acordo com a metodologia JBI e com a redação guiada pelo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. A busca foi realizada em setembro de 2021 por dois revisores independentes nas bases de dados referenciais e em portais de informação e de literatura cinzenta, utilizando majoritariamente os descritores “heart failure”, “signs and symptoms” e “palliative care”, com o operador booleano “and”, sem recorte temporal. Resultados Foram incluídos 34 artigos publicados entre 2001 e 2021, provenientes de revistas nacionais e internacionais, sendo 21 publicados nos Estados Unidos da América. Por meio desses artigos, foi possível mapear 93 sinais e sintomas, sendo que os mais frequentes foram dor, dispneia, fadiga, náusea e depressão. Conclusão Implicações para a prática esta revisão de escopo produziu um mapa da produção científica sobre os sinais e sintomas de insuficiência cardíaca em cuidados paliativos. O conhecimento dos sinais e sintomas auxilia os profissionais da saúde no desenvolvimento de técnicas e tecnologias para avaliar a severidade da insuficiência cardíaca, planejar intervenções paliativas e avaliar os seus resultados.
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daSilva-deAbreu A, Lavie CJ, Mehra MR. Bridging the palliative care chasm in advanced heart failure. Int J Cardiol 2021; 338:147-149. [PMID: 34144074 DOI: 10.1016/j.ijcard.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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