Tania Pastrana, Matthew Grant, Paula Hidalgo Andrade, Daniele Marelli, Klaus Witte, Geert-Jan Geersing, Carla Ripamonti, Roman Rolke, Marco Metra, Matteo Pagnesi, Everlien De Graaf, Cosimo Chelazzi
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We aim to map how current national and international guidelines recommend integrating palliative care into HF management across the 10 countries represented by the EU-funded RAPHAEL consortium (Horizon Europe programme, No 101137170): Belgium, Germany, Lithuania, the Netherlands, Spain, Italy, Poland, Sweden, Switzerland and the United Kingdom. A systematic search was conducted across six databases (EMBASE, Global Health, MEDLINE, PsycINFO, The Cochrane Library and Web of Science) for publications from 1 January 2000 to 25 May 2024. Eligible publications focused on adults with HF and models of palliative care integration. Data were synthesized using content analysis. Of 1543 records screened, 13 publications were included. Most studies were guidelines, consensus or position papers; only one was qualitative research. The definition of the population with HF eligible for palliative care was heterogeneous and inconsistently defined, mostly by symptoms (4/13 publications; 31%) and pathophysiology (2/13; 15%). The most frequent triggers for palliative care referral were clinical features and symptoms (8/13; 62%), patients approaching the end of life (8/13; 62%), and symptomatic deterioration despite optimal therapy (7/13; 54%). Additional triggers included multiple (>1) unplanned hospitalizations (6/13; 46%) and spiritual, emotional or social issues (7/13; 54%). Outcomes of palliative care referral for HF patients focused on quality of life (9/13; 69%) and symptom control (9/13; 69%). Multiprofessional involvement was emphasized with cardiologists (12/13; 92%), nurses (10/12; 77%), palliative care specialists (9/13; 69%) and primary care physicians (4/13; 31%). Publications generally noted that despite increased awareness and recommendations, referrals remain low and mostly late stages. 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引用次数: 0
摘要
心力衰竭(HF)在欧洲是一个日益严重的健康和社会挑战,原因是老年、体弱和多病人群日益增多。许多心衰患者经历复杂和多方面症状的沉重负担,导致生活质量下降和显著的社会经济影响。尽管证明了益处,但将姑息治疗纳入心衰管理途径仍然不一致且未得到充分利用。我们的目标是绘制当前国家和国际指南如何建议在欧盟资助的RAPHAEL联盟(Horizon Europe项目,No . 101137170)所代表的10个国家将姑息治疗纳入心衰管理的地图:比利时、德国、立陶宛、荷兰、西班牙、意大利、波兰、瑞典、瑞士和英国。系统检索了六个数据库(EMBASE、Global Health、MEDLINE、PsycINFO、Cochrane图书馆和Web of Science) 2000年1月1日至2024年5月25日的出版物。合格的出版物集中于HF成人和姑息治疗整合模型。采用内容分析法对数据进行综合。在筛选的1543份记录中,包括13份出版物。大多数研究是指导方针、共识或立场文件;只有一个是定性研究。有资格接受姑息治疗的心衰人群的定义是异质且不一致的,主要是通过症状(4/13篇,31%)和病理生理学(2/13篇,15%)来定义。姑息治疗转诊最常见的触发因素是临床特征和症状(8/13;62%),患者接近生命终点(8/13;62%),以及最佳治疗后症状恶化(7/13;54%)。其他触发因素包括多次计划外住院(6/13;46%)和精神、情感或社会问题(7/13;54%)。心衰患者姑息治疗转诊的结果主要集中在生活质量(9/13;69%)和症状控制(9/13;69%)。强调多专业参与,包括心脏病专家(12/13;92%)、护士(10/12;77%)、姑息治疗专家(9/13;69%)和初级保健医生(4/13;31%)。出版物普遍指出,尽管提高了认识并提出了建议,但转诊仍然很低,而且大多处于后期阶段。这篇综述强调了在欧洲HF管理中需要结构化的、早期整合姑息治疗,明确姑息治疗转诊的触发因素,应用标准化途径和促进多专业合作。制定这些措施,同时通过制定政策解决实施方面的挑战,可以改善患者的治疗效果和生活质量。
Mapping of current practices of palliative care for patients with heart failure throughout Europe: A scoping review.
Heart failure (HF) is a growing health and societal challenge in Europe, due to an increasingly elderly, frail and multimorbid population. Many patients with HF experience a high burden of complex and multidimensional symptoms leading to a reduced quality of life and significant socioeconomic impact. Despite proven benefits, the integration of palliative care into HF management pathways remains inconsistent and underutilized. We aim to map how current national and international guidelines recommend integrating palliative care into HF management across the 10 countries represented by the EU-funded RAPHAEL consortium (Horizon Europe programme, No 101137170): Belgium, Germany, Lithuania, the Netherlands, Spain, Italy, Poland, Sweden, Switzerland and the United Kingdom. A systematic search was conducted across six databases (EMBASE, Global Health, MEDLINE, PsycINFO, The Cochrane Library and Web of Science) for publications from 1 January 2000 to 25 May 2024. Eligible publications focused on adults with HF and models of palliative care integration. Data were synthesized using content analysis. Of 1543 records screened, 13 publications were included. Most studies were guidelines, consensus or position papers; only one was qualitative research. The definition of the population with HF eligible for palliative care was heterogeneous and inconsistently defined, mostly by symptoms (4/13 publications; 31%) and pathophysiology (2/13; 15%). The most frequent triggers for palliative care referral were clinical features and symptoms (8/13; 62%), patients approaching the end of life (8/13; 62%), and symptomatic deterioration despite optimal therapy (7/13; 54%). Additional triggers included multiple (>1) unplanned hospitalizations (6/13; 46%) and spiritual, emotional or social issues (7/13; 54%). Outcomes of palliative care referral for HF patients focused on quality of life (9/13; 69%) and symptom control (9/13; 69%). Multiprofessional involvement was emphasized with cardiologists (12/13; 92%), nurses (10/12; 77%), palliative care specialists (9/13; 69%) and primary care physicians (4/13; 31%). Publications generally noted that despite increased awareness and recommendations, referrals remain low and mostly late stages. This review underscores the need for structured, early integration of palliative care in HF management across Europe with clear triggers for palliative care referral, application of standardized pathways and fostering of multiprofessional collaboration. Developing these, while simultaneously addressing implementation challenges through policy development, could improve patient outcomes and quality of life.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.