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Rozenberg D, Andrawes RR, Wentlandt K. An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes. Curr Opin Pulm Med 2024; 30:410-418. [PMID: 38533802 DOI: 10.1097/mcp.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) in lung transplantation is increasingly acknowledged for its important role in addressing symptoms, enhancing functionality, and facilitating advance care planning for patients, families, and caregivers. The present review provides an update in PC management in lung transplantation. RECENT FINDINGS Research confirms the effectiveness of PC for patients with advanced lung disease who are undergoing transplantation, showing improvements in symptoms and reduced healthcare utilization. Assessment tools and patient-reported outcome measures for PC are commonly used in lung transplant candidates, revealing discrepancies between symptom severity and objective measures such as exercise capacity. The use of opioids to manage dyspnea and cough in the pretransplant period is deemed safe and does not heighten risks posttransplantation. However, the integration of PC support in managing symptoms and chronic allograft dysfunction in the posttransplant period has not been as well described. SUMMARY Palliative care support should be provided in the pretransplant and select peri-operative and posttransplant periods to help support patient quality of life, symptoms, communication and daily function.
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Affiliation(s)
- Dmitry Rozenberg
- Temerty Faculty of Medicine, University of Toronto
- Respirology and Lung Transplantation, University Health Network
- Toronto General Hospital Research Institute, University Health Network
| | - Rogih Riad Andrawes
- Temerty Faculty of Medicine, University of Toronto
- Toronto General Hospital Research Institute, University Health Network
| | - Kirsten Wentlandt
- Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto
- Division of Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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2
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Ali HJ, Sahay S. End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities. Semin Respir Crit Care Med 2023; 44:866-876. [PMID: 37459883 DOI: 10.1055/s-0043-1770124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care revolves around symptom palliation and reducing psychosocial disease burden for a dying patient and entails advanced care planning that are often challenging. Thus, support from palliative care specialist becomes extremely important in these patients. Early introduction to palliative care in patients with high symptom burden and psychosocial suffering is suggested. Despite of the benefits of an early intervention, palliative care remains underutilized in patients with PAH, and this significantly raises issues around end-of-life care in PAH. In this review, we will discuss the opportunities offered and the existing barriers in addressing high symptom burden and end-of-life care issues. We will focus on the current evidence, identify areas for future research, and provide a call-to-action for better guidance to PAH specialists in making timely, appropriate interventions that can help mitigate end-of-life care issues.
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Affiliation(s)
- Hyeon-Ju Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Sandeep Sahay
- Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Lung Center, Houston Methodist Hospital, Houston, Texas
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3
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Brown CE, Steiner JM, Modes M, Lynch Y, Leary PJ, Curtis JR, Engelberg RA. Palliative Care Perspectives of Patients with Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2023; 20:331-334. [PMID: 36416739 PMCID: PMC9989860 DOI: 10.1513/annalsats.202208-721rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Matthew Modes
- University of WashingtonSeattle, Washington
- Cedars-Sinai Medical CenterLos Angeles, California
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4
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Rohlfing AB, Bischoff KE, Kolaitis NA, Kronmal RA, Kime NA, Gray MP, Bartolome S, Chakinala MM, Frantz RP, Ventetuolo CE, Mathai SC, De Marco T. Palliative care referrals in patients with pulmonary arterial hypertension: The Pulmonary Hypertension Association Registry. Respir Med 2023; 206:107066. [PMID: 36470050 DOI: 10.1016/j.rmed.2022.107066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a life limiting disease with substantial symptom burden and healthcare utilization. Palliative care alleviates physical and emotional symptoms for patients with serious illness, and has been underutilized for these patients. OBJECTIVE To characterize patients with PAH referred to palliative care and identify predictors of referral. METHODS We conducted an observational study of adult patients enrolled in the Pulmonary Hypertension Association Registry from January 2015 through June 2021, performing descriptive statistics on patient characteristics at baseline for all patients and the subset referred to palliative care. These characteristics were modeled in a backwards elimination Cox regression with time to referral to palliative care as the primary outcome. RESULTS 92 of 1,578 patients were referred to palliative care (5.8%); 43% were referred at their last visit prior to death. Referrals were associated with increasing age per decade (hazard ratio 1.35 [95% confidence interval 1.16-1.58]), lower body mass index (hazard ratio 0.97 [95% confidence interval 0.94-0.998]), supplemental oxygen use (hazard ratio 2.01 [95% confidence interval 1.28-3.16]), parenteral prostanoid use (hazard ratio 2.88 [95% confidence interval 1.84-4.51]), and worse quality of life, measured via lower physical (hazard ratio 0.97 [95% confidence interval 0.95-0.99]) and mental (hazard ratio 0.98 [95% confidence interval 0.96-0.995]) scores on the 12-item Short Form Health Survey. CONCLUSION Patients with PAH are infrequently referred to palliative care, even at centers of excellence. Referrals occur in sicker patients with lower quality of life scores, often close to the end of life.
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Affiliation(s)
- Anne B Rohlfing
- Extended Care & Palliative Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, United States; Division of Primary Care & Population Health, Stanford Medicine, Stanford, CA, United States.
| | - Kara E Bischoff
- Division of Palliative Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Nicholas A Kolaitis
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Noah A Kime
- Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Michael P Gray
- Faculty of Medicine & Health, Division of Cardiology, University of Sydney Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Sonja Bartolome
- Division of Pulmonary & Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Murali M Chakinala
- Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine, St Louis, MO, United States.
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Corey E Ventetuolo
- Division of Pulmonary, Critical Care & Sleep Medicine, Brown University, Providence, RI, United States.
| | - Stephen C Mathai
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Teresa De Marco
- Division of Cardiology, University of California San Francisco, San Francisco, CA, United States.
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Lv Y, Ma P, Wang J, Xu Q, Fan J, Yan L, Ma P, Zhou R. Betaine alleviates right ventricular failure via regulation of Rho A/ROCK signaling pathway in rats with pulmonary arterial hypertension. Eur J Pharmacol 2021; 910:174311. [PMID: 34245749 DOI: 10.1016/j.ejphar.2021.174311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023]
Abstract
Pulmonary vascular remodeling was shown to lead to pulmonary arterial hypertension (PAH), further trigger excessive apoptosis of cardiomyocytes, and ultimately cause right ventricular failure (RVF), which involves the activation of Rho A/ROCK signaling pathway. Betaine has been found efficacious for attenuating PAH through its anti-inflammatory effects in our previous research while its effects on RVF due to PAH remains inconclusive. Thus, we attempted to elucidate the protective effects of betaine on PAH, RVF due to PAH as well as the potential mechanisms. To this end, male Sprague Dawley rats received a single subcutaneous injection of monocrotaline (50 mg/kg) to imitate PAH and RVF, and subsequently oral administration of betaine (100, 200, and 400 mg/kg/day). Betaine treatment improved the hemodynamics and histomorphological parameters and echocardiographic changes. Moreover, betaine also alleviated the pulmonary vascular remodeling and cardiomyocyte apoptosis. The mechanisms study revealed that administration of betaine significantly increased the expression of Rho A, ROCK1, and ROCK2. Furthermore, betaine alleviated the changes of its downstream molecules P53, Bcl-2, Bax, phosphorylated MYPT1 (p-MYPT1), total MYPT1 (t-MYPT1), p27kip1, and Cleaved Caspase-3. According to what we observed, this study indicated that betaine treatment could protect RVF due to PAH, which may be achieved through an altered Rho A/ROCK signaling pathway.
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Affiliation(s)
- Yingjie Lv
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Pengsheng Ma
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Jialing Wang
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Qingbin Xu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jun Fan
- Shizuishan Center for Disease Control and Prevention, Shizuishan, China
| | - Lin Yan
- College of Basic Medicine, Ningxia Medical University, Yinchuan, China
| | - Ping Ma
- General Hospital of Ningxia Medical University, Yinchuan, China.
| | - Ru Zhou
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China; Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan, China; Ningxia Characteristic Traditional Chinese Medicine Modernization Engineering Technology Research Center, Ningxia Medical University, Yinchuan, China.
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Baumann T, Das S, Jarrell JA, Nakashima-Paniagua Y, Benitez EA, Gazzaneo MC, Villafranco N. Palliative Care in Pediatric Pulmonology. CHILDREN 2021; 8:children8090802. [PMID: 34572234 PMCID: PMC8466481 DOI: 10.3390/children8090802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with cystic fibrosis, bronchopulmonary dysplasia, neuromuscular disease, pulmonary hypertension, and lung transplantation from Texas Children’s Hospital. We discuss the expected clinical course of each condition, then review the integration of primary and specialized palliative care into the management of each diagnosis. This paper then reviews the management of two children with end staged lung disease at Hospital Civil de Guadalajara, providing an additional perspective for approaching palliative care in low-income countries.
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Affiliation(s)
- Taylor Baumann
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Shailendra Das
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Jill Ann Jarrell
- Section of Palliative Care, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Yuriko Nakashima-Paniagua
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Edith Adriana Benitez
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Maria Carolina Gazzaneo
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Natalie Villafranco
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
- Correspondence:
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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8
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Wong CY, Tsang KW, Li CW, Au HY, Chan KY. Roles of specific drug therapies for severe pulmonary arterial hypertension in palliative care: a case report. AME Case Rep 2021; 5:7. [PMID: 33634247 DOI: 10.21037/acr-20-108] [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: 06/12/2020] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
Pulmonary arterial hypertension (PAH) is an uncommon but potentially life-threatening illness. The elevated pulmonary arterial blood pressure will lead to right heart failure and even cardiopulmonary collapse if it is severe. Apart from general supportive measures, pulmonary hypertension-specific therapies (PHST) are available to slow down disease progression, but they are not curative. According to previous studies, many patients with severe PAH often had significant physical symptoms and psychological distress for both themselves and their families at the end of life. Moreover, they would have repeated admissions due to physical deterioration and decline in functioning associated with worsening in cardiac function. Some of these patients might suffer from unnecessary aggressive interventions and resuscitation because of lack of advance care planning discussion. As such, Palliative Care (PC) would be an important element as part of the overall management. Hereby, we reported a patient with severe PAH and schizoaffective disorder achieved good outcome from the use of combination PHST and PC input. Her physical and psychosocial needs could be addressed well by PC team. This case report showed the collaborative work between PC and parent teams. While parent team was able to manage the medical conditions related to PAH, however the physical and psychosocial needs should be addressed by PC team. More importantly, the PC team has essential roles of providing advance care planning discussions with the patient and help to reduce unnecessary interventions. Furthermore, PC would coordinate the community service to support her while staying at home. Roles of PHST will also be discussed in this case. Clinicians must take into account possible hemodynamic effects of any palliative intervention for PAH.
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Affiliation(s)
- Chi Yan Wong
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Kwok Wai Tsang
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Cho Wing Li
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Ho Yan Au
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Kwok Ying Chan
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
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Palliative Care in Pulmonary Arterial Hypertension. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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