评估恶化心衰患者的姑息治疗需求：来自OPPORTUNITIES登记的见解

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-11 DOI:10.1016/j.ijcard.2025.133491

Emilia D’Elia , Ottavio Zucchetti , Francesco Pedrazzoli , Alberto Cereda , Cinzia Giaccherini , Edoardo Sciatti , Salvatore D’Isa , Luca Di Odoardo , Laura Tomasoni , Antonello Gavazzi , Mauro Gori , Roberta Marchesi , Simonetta Cesa , Michele Senni

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引用次数: 0

摘要

背景：心衰（WHF）患者住院次数频繁，生活质量（QoL）下降。姑息治疗（PC）被认为是心衰管理的关键，但其整合代表了一个未满足的需求。目的本研究旨在利用姑息治疗需求评估工具（PCNAT）评估WHF患者的PC需求，并将结果与生物标志物、临床结局和预后评分相关联。方法对144例WHF患者在意大利北部贝加莫Papa Giovanni XXIII医院的专用设施进行前瞻性评估。根据PCNAT的最高分位数对患者进行分层，将PCNAT≥10或<分为两组；10. 主要结局是全因死亡率、心衰住院（HHF）、急诊室（ER）就诊或紧急临床评估和转介给心衰专家的综合结果。结果中位随访时间为91天。33%的患者（47/144）PCNAT评分≥10。这些患者体重指数较低，NYHA分级较差，合并症较多，包括慢性肾病、糖尿病和心房颤动。他们也表现出较差的生物标志物和较低的指导药物治疗使用，较高的利尿剂剂量。预后评分、生活质量与PCNAT评分有显著相关。Kaplan-Meier分析证实PCNAT评分越高的患者的临床事件发生率越高。单因素和多因素Cox回归分析显示PCNAT评分是临床结局的重要独立预测因子。结论pcnat能有效地将WHF患者按PC需求进行分层，与较差的临床预后相关。早期整合PC可以改善以患者为中心的护理，突出了系统转诊途径的必要性。

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Assessing palliative care needs in worsening heart failure patients: Insights from OPPORTUNITIES registry

Background

Worsening heart failure (WHF) patients experience frequent hospitalizations and reduced quality of life (QoL). Palliative care (PC) is recognized as essential for HF management, but its integration represent an unmet need.

Objective

This study aimed to assess PC needs in WHF patients using the Palliative Care Needs Assessment Tool (PCNAT), and correlate the findings with biomarkers, clinical outcomes and prognostic scores.

Methods

144 WHF patients were prospectively evaluated at the dedicated facility in Papa Giovanni XXIII Hospital in Bergamo, Northern Italy. Patients were stratified by the highest tertile of PCNAT, identifying two groups with PCNAT≥10 or < 10. The primary outcome was the composite of all-cause mortality, HF hospitalization (HHF), emergency room (ER) visits or urgent clinical evaluation and referral to PC specialist.

Results

The median follow-up was 91 days. Thirty-three percent of patients (47/144) had a PCNAT score ≥ 10. These patients had lower body mass index, worse NYHA class and more comorbidities, including chronic kidney disease, diabetes, and atrial fibrillation. They also showed worse biomarkers and lower guideline directed medical therapy use, with higher diuretic doses. Prognostic scores and QoL were significantly correlated with PCNAT score. Kaplan-Meier analysis confirmed higher clinical event rates in patients with higher PCNAT scores. Univariate and multivariate Cox regression analysis showed that PCNAT score was a significant independent predictor of clinical outcomes.

Conclusion

PCNAT effectively stratifies WHF patients by PC needs, correlating with poorer clinical outcomes. Early integration of PC could improve patient-centred care, highlighting the need for systematic referral pathways.

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.