目的:研究符合姑息治疗计划纳入标准的功能分级(FC)III-IV型慢性心力衰竭(CHF)患者的临床特征和预后。
方法:在萨马拉地区的60个门诊和住院诊所进行了为期一个月的严重CHF表格简短登记(16.05.2022-15.06.2022)。登记包括在此期间寻求医疗帮助的FCIII-IVCHF患者。使用死亡率信息和分析系统在纳入注册表后90天评估致死结果。
结果:591例患者(中位年龄,注册71.0[64.0;80.0]年,包括339名(57.4%)男性,其中149人(24.1%)为工作年龄(65岁以下)。CHF的主要病因为缺血性心脏病(64.5%)。229例(38.7%)患者左心室射血分数为40%。在过去的一年里,513例(86.8%)患者至少有一次因失代偿性CHF住院。45.7%的患者有胸水,11.3%的患者有腹水。在超过25%的患者中观察到低收缩压;14.2%需要院内正性肌力支持;9.1%的人在门诊接受。4.2%的患者接受了门诊氧气支持,0.8%的患者需要使用麻醉性镇痛药。12名(1.9%)患者在等待心脏移植的名单上。在这项研究中,室性心动过速和/或左束支传导阻滞(LBBB)患者中植入心脏再同步治疗装置(CRTD)或植入式心律转复除颤器(ICD)的患者数量不一致,共有19例患者(11例CRTD患者和8例ICD患者),58例(9.8%)患者有CRTD/ICD植入指征。在列入登记册后的90天内,59例(10.0%)患者死亡。根据二元逻辑回归分析,LBBB的存在,胸腔积液,门诊氧气支持的要求,心脏手术史与高死亡风险相关.
结论:重度CHF患者不仅需要适当的药物治疗,而且动态临床观察辅以旨在改善生活质量的姑息治疗,包括共同决策和提前护理计划的道德原则,以确定患者与护理相关的优先事项和目标。
OBJECTIVE: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.
METHODS: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.
RESULTS: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had
hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB,
hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.
CONCLUSIONS: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.