背景:在像日本这样的老龄化社会中,老年人的数量继续增加,为所有死亡提供医院内临终关怀,以及医院以外的临终关怀,例如在家里或养老院,将是困难的。在临终关怀中,监测患者对于了解他们的病情和预测生存时间很重要;这些信息为家庭成员和护理人员提供了为生命结束做准备的时间。然而,没有明确的指标,医疗保健提供者必须主观地决定老年患者是否处于生命终结阶段,考虑到条件变化和食物摄入减少等因素。这使得家庭成员的决定变得复杂,尤其是在家庭护理期间。
目的:这项初步回顾性研究的目的是确定在绝症老年患者死亡之前,是否以及如何通过心冲击描记术(BCG)估计心率变异性(HRV)指数发生改变。并最终从变化点预测死亡日期。
方法:这项回顾性试点研究评估了2019年8月至2021年12月期间入住特殊疗养院的15名老年患者的医疗记录。患者特征和时域HRV指标,如平均正常到正常(ANN)间隔,正常到正常(SDNN)间隔的SD,收集死亡日期前至少2个月的连续差异均方根(RMSSD)。通过绘制有限的三次样条曲线来检查指数的总体趋势。进行重复测量ANOVA以评估在观察期内指数的变化。为了探索更详细的HRV变化,采用分段回归分析估计HRV指数的变化点.
结果:15名患者包括8名男性和7名女性,中位年龄为93岁(IQR91-96)。三次样条曲线显示指数从患者死亡前大约30天开始逐渐下降。重复测量方差分析显示,与死亡前8周相比,死亡前3周,ANN(0.90,95%CI0.84-0.98;P=.005)和RMSSD(0.83,95%CI0.70-0.99;P=.03)的几何平均值比值开始下降.分段回归分析估计了神经网络的变化点,SDNN,RMSSD为-34.5(95%CI-42.5至-26.5;P<.001),-33.0(95%CI-40.9至-25.1;P<.001),和-35.0(95%CI-42.3至-27.7;P<.001)天,分别,在死亡之前。
结论:这项初步研究确定了老年患者生命末期死亡前HRV指数的变化点。尽管检查的数据很少,我们的研究结果表明,来自BCG的HRV指数可用于监测和预测老年患者在生命末期的生存时间.研究和结果表明,在预测临终结果方面,更客观和准确的预后工具的潜力。
BACKGROUND: In an aging society such as Japan, where the number of older people continues to increase, providing in-hospital end-of-life care for all deaths, and end-of-life care outside of hospitals, such as at home or in nursing homes, will be difficult. In end-of-life care, monitoring patients is important to understand their condition and predict survival time; this information gives family members and caregivers time to prepare for the end of life. However, with no clear indicators, health care providers must subjectively decide if an older patient is in the end-of-life stage, considering factors such as condition changes and decreased food intake. This complicates decisions for family members, especially during home-based care.
OBJECTIVE: The purpose of this preliminary retrospective
study was to determine whether and how changes in heart rate variability (HRV) indices estimated from ballistocardiography (
BCG) occur before the date of death in terminally ill older patients, and ultimately to predict the date of death from the changepoint.
METHODS: This retrospective pilot
study assessed the medical records of 15 older patients admitted to a special nursing home between August 2019 and December 2021. Patient characteristics and time-domain HRV indices such as the average normal-to-normal (ANN) interval, SD of the normal-to-normal (SDNN) interval, and root mean square of successive differences (RMSSD) from at least 2 months before the date of death were collected. Overall trends of indices were examined by drawing a restricted cubic spline curve. A repeated measures ANOVA was performed to evaluate changes in the indices over the observation period. To explore more detailed changes in HRV, a piecewise regression analysis was conducted to estimate the changepoint of HRV indices.
RESULTS: The 15 patients included 8 men and 7 women with a median age of 93 (IQR 91-96) years. The cubic spline curve showed a gradual decline of indices from approximately 30 days before the patients\' deaths. The repeated measures ANOVA showed that when compared with 8 weeks before death, the ratio of the geometric mean of ANN (0.90, 95% CI 0.84-0.98; P=.005) and RMSSD (0.83, 95% CI 0.70-0.99; P=.03) began to decrease 3 weeks before death. The piecewise regression analysis estimated the changepoints for ANN, SDNN, and RMSSD at -34.5 (95% CI -42.5 to -26.5; P<.001), -33.0 (95% CI -40.9 to -25.1; P<.001), and -35.0 (95% CI -42.3 to -27.7; P<.001) days, respectively, before death.
CONCLUSIONS: This preliminary
study identified the changepoint of HRV indices before death in older patients at end of life. Although few data were examined, our findings indicated that HRV indices from
BCG can be useful for monitoring and predicting survival time in older patients at end of life. The study and results suggest the potential for more objective and accurate prognostic tools in predicting end-of-life outcomes.