Risultati per: Linee guida pratiche sulle cure palliative

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Circulation, Volume 148, Issue Suppl_1, Page A13526-A13526, November 6, 2023. Background:Palliative care services (PCS) is crucial in the care of end-stage heart failure (ESHF) patients. However, there is limited data on the utilization rates and the predictors PCS in ESHF patients.Research question:What is the frequency of PCS utilization, and what are the predictors of PCS use in ESHF patients?Methods:ESHF admissions were identified from the National Inpatient Sample database from 2018 – 2020. The identified admissions were stratified based on the use of PCS. The primary outcomes were the rate of utilization, and the predictors of PCS use in ESHF patients. Multivariate logistic regression and propensity matching were used to adjust for confounders.Results:In total, 147,140 ESHF admissions were identified, of which only 6.2% (9170) had PCS use. Patients with PCS were older(71.66 years vs 63.78 years; p

Circulation, Volume 148, Issue Suppl_1, Page A17891-A17891, November 6, 2023. Background:Cardiogenic shock (CS) is associated with significant mortality. The 2022 ACC/AHA/HFSA guidelines discuss the importance of palliative care (PC) in advanced heart disease, but PC and end-of-life care (EOLC) integration after CS is not well characterized. We aimed to study the use of PC and EOLC planning after CS.Hypothesis:We assessed the hypothesis that PC consults and EOLC planning are underutilized after CS.Methods:This is a retrospective observational study of 63 consecutive patients at a quaternary care center in Boston diagnosed with CS between January and April 2022. CS onset and etiology were adjudicated by treating physicians.Results:Of 63 patients with CS (mean age 61±14 years, 30% Female, 73% White), 26 (41%) died during admission and 31 (49%) survived 1 year after CS onset. Only 6 patients (10%) received PC consults for EOLC considerations (consults placed on average 9 days from CS onset) (Table 1). Only 24 (38%) had documented advanced care plans after developing CS, of which 14 were documented by PC consultants. Of 44 patients with MCS or ICD placed, only 1 had a documented discussion about the option of discontinuing the therapy in the future. After CS, 28 (44%) had changes in resuscitation limits. Only 1 patient had their preferred location of death documented. Palliative inotropes were prescribed to 2 patients at discharge, and 3 patients were discharged to hospice. Readmission rates at 3 and 6 months were 24% and 36%, respectively.Conclusions:PC and EOLC planning are underutilized after CS, despite the significant mortality of CS. Secondary PC models may not be optimal for CS, given the acute presentation of CS and bimodal distribution of survival after onset. These data demonstrate a compelling need to address key considerations that impact EOLC after CS, such as resuscitation limits, duration of advanced therapies, and goal-concordant discharge locations. Further research is needed to explore optimal models of PC and EOLC integration after CS.

Circulation, Volume 148, Issue Suppl_1, Page A13743-A13743, November 6, 2023. Backgrounds:Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care similar to those with cancer, most HF patients do not receive timely intervention due to the absence of standardized method for identifying those in need of palliative care. Several tools have been employed to assess palliative care needs and identify eligible patients. However, their validity and reliability have yet to be fully examined worldwide. We sought to assess the validity and reliability of The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) in Japanese HF population.Methods:We enrolled consecutive HF patients admitted in our university hospital between February and May 2023 and their caregivers were also included. The NAT: PD-HF were translated into Japanese by our professional multidisciplinary team in accordance with cultural and medical background. We assessed the internal consistency of the NAT: PD-HF with Cronbach`s alpha, and the inter-rater and test-retest reliability with Cohen`s kappa. After using this tool, patients, caregivers, and health care providers were asked whether the tool adequately identify their burden and care needs.Results:During the study period, 75 patients, 67 caregivers, and 17 health care providers agreed to participate. Cronbach’s alpha was 0.80 and the minimum Kappa coefficient was 0.73 for inter-rater reliability and 0.83 for test-retest reliability. Seventy-one patients (94%) and 64 caregivers (95%) found this tool useful to identify their burden and care needs. Seventy patients (93%) and 63 caregivers (94%) felt that the tool will improve the quality of care. Sixteen health care providers (94%) also believed this tool was helpful to understand the burden and care needs of both patients and caregivers. However, 7 of them (41%) considered they may not have enough time to use the tool in their daily clinical practice.Conclusions:The NAT: PD-HF was suggested to be a reliable and potentially valid tool even among Japanese HF patients. This tool was very well accepted by patients, caregivers, and health care providers to identify burden and care needs. Further follow-up studies are needed to examine the prognostic impact of using this tool.

This JAMA Internal Medicine Patient Page describes details of palliative care, including who it can benefit and when it should be considered.

This Viewpoint describes specific issues related to severe mental illnesses for palliative care.

Al centro cure palliative pediatriche e sostegno a caregiver

Lo rivela una ricerca IRCCS San Martino durata 15 anni

Lo rivela una ricerca IRCCS San Martino durata 15 anni