Risultati per: I farmaci da utilizzare nelle cure palliative

Circulation, Volume 150, Issue Suppl_1, Page A4143804-A4143804, November 12, 2024. Introduction:Palliative care interventions for patients with heart failure have been shown to significantly improve quality of life, reduce symptom burden, and enhance functional status. Timing of referral becomes challenging as disease progresses and readmission rates increase. We studied factors associated with inpatient mortality in patients with end stage heart failure, ineligible for additional advanced therapies.Methods:Individuals with acute decompensated heart failure admitted between 2021-2023, who were ineligible for further advanced cardiac therapies and referred to palliative care, were included to this retrospective study. Data on demographic variables, clinical parameters (NYHA classification, Karnofsky Performance Scale (KPS) scores, comorbidities, type of heart disease, BNP, albumin, creatinine levels), and palliative care interventions (symptom burden assessments, family meetings, and advanced care planning (ACP) discussions) were collected. We conducted bivariate and multivariate analyses using Kruskal-Wallis and chi-square tests, and adjusted regression models to compare characteristics between individuals who died while admitted and survivors.Results:A total of 97 individuals were included in the study, with a mean age of 68 ± 17.7 years, 33.0%(n=32) of whom were female. Patients who died during admission had significantly higher rate of established ACP following palliative care consult (p< 0.01) and had a shorter time from consultation to discharge and were more likely to be declared DNR/DNI during admission. Hospital length of stay was shorter for patients who died in the hospital Lower KPS scores, with KPS scores

Circulation, Volume 150, Issue Suppl_1, Page A4139646-A4139646, November 12, 2024. Background:Heart failure (HF) affects 6.7 million Americans and causes 500,000 deaths annually. Despite advancements in treatment, the 1-year mortality in advanced HF is 25-50%. Implantable left ventricular assist devices (LVAD) are critical for bridge-to-transplant or destination therapy, with 1-year and 2-year survival rates of 80% and 70%, respectively. At least 67% of LVAD patients have palliative care (PC) needs. However, PC involvement rates have been variable. The aim of this study is to measure the utilization of PC focusing on demographic disparities.Methods:Data was obtained from the National Inpatient Sample (NIS) 2021 database to identify patients with a principal diagnosis of HF (ICD I50.xx), secondary diagnoses of LVAD placement (Z45.2, Z95.811) and utilization of PC during encounter (Z51.5). Analysis was performed using SPSS statistical software.Results:Out of 5,688,355 adult hospitalizations in 2021, 1,048,573 patients were hospitalized with a primary diagnosis of HF. About 7.46% of HF patients received PC. Among these, patients over 75 years old, who constituted 44.4% of the cohort, accounted for 62.6% of PC involvement. PC consultation rates were similar between sexes. White patients made up 67.8% of the HF population but represented 73.6% of PC consultations, while other minority groups had a lower proportion of PC consultations.LVADs were implanted in 0.09% of HF patients, with 69.5% between 50-74 years old. A significant gender disparity was noted; 76.6% of LVAD recipients were male, and 23.4% female.PC was only involved in the care of 17.2% of LVAD patients. Age distribution of LVAD patients PC mirrored the overall LVAD cohort. Gender disparity persisted, with 80.4% of LVAD patients receiving PC being male, and 19.6% female. Racial disparities were less pronounced in this group.Conclusion:Despite proven benefits of PC involvement on the quality of life, psychological well being, and advanced care planning, specific guidelines in LVAD patients are yet to be established. This study underscores the need for more comprehensive guidelines promoting PC integration in the management of LVAD patients, and highlights demographic disparities in PC utilization among HF and LVAD patients.

Circulation, Volume 150, Issue Suppl_1, Page A4141265-A4141265, November 12, 2024. Background:Congenital heart disease (CHD) is a common congenital anomaly with lesions requiring intervention before initial hospital discharge defined as critical CHD (CCHD). Advances in prenatal detection, surgical, and post-operative care have improved early survival of patients with CCHD, yet long-term survival is limited. Fetal echocardiography has improved diagnosis and characterization of CCHD, and prenatal palliative care (PC) consult can improve shared decision making, communication, and parental stress of patients with life-limiting conditions. We hypothesized that the utilization of prenatal PC consults for patients with CCHD would be low (

Circulation, Volume 150, Issue Suppl_1, Page A4147316-A4147316, November 12, 2024. Background:Outpatient palliative care has been associated with improved health-related quality-of-life (HRQoL) in patients with heart failure. However, there is limited understanding of its utilization among patients with long-term left ventricular assist device (LT-LVAD) therapy. The prevalence of LVAD implantation as long-term therapy has increased over the past decade; these patients may particularly benefit from outpatient palliative care.Objective:To identify the predictors of outpatient palliative care utilization in a sample of LT-LVAD patients from a high-volume LVAD center.Methods:This retrospective chart review analyzed data from 270 patients who received LVAD as long-term therapy between January 1, 2017, and December 30, 2021, and were supported on LVAD therapy for at least two years. Patients who received heart transplantation prior to the study end-date were excluded. Logistic regression models were used to estimate the odds of receiving outpatient palliative care (with or without inpatient palliative care) versus receiving inpatient palliative care alone.Results:Among 270 patients, the mean age was 62 years (+/- 12), 74.2% were male, 79.0% Black and 17.3% White. By device: 77.4% received HeartMate 3™ (HM3), 19.6% HVAD™ LVAD, 3.0% HeartMate II™. Patients lived an average of 4 years (+/- 1) post-implantation. The mean number of hospitalizations from implantation to death or end-of-study was 7.85 (+/- 7.04). 180 patients received inpatient palliative care consultation alone; 90 patients received at least one outpatient palliative care visit. Black patients had increased odds of receiving outpatient palliative care compared to White patients (OR 2.27, P=0.040). For each additional hospitalization a patient experienced, the odds of receiving outpatient palliative care increased (OR 1.06, P=0.002). Patients with HVAD™ LVAD were less likely to receive outpatient palliative care than those with HM3 (OR 0.45, P=0.029).Conclusion:In this large cohort of patients supported on LT-LVAD therapy, Black patients were more likely to receive outpatient palliative care than White patients. More frequent hospitalizations and LVAD type were associated with an increased likelihood of outpatient palliative care visits. Future studies should explore the factors contributing to these differences to better understand and enhance palliative care utilization for all patients on LT-LVAD therapy.

Pazienti, pronti a dare contributo per nuova sanità territoriale

Aiom, terapia ormonale salvavita. Soluzioni smart per ricordarla

Quality of life for patients with advanced non–small-cell lung cancer was similar with virtual delivery and in-person delivery of early palliative care.

Per il numero uno delle imprese farmaceutiche il mancato rialzo del tetto della spesa fa alzare il payback a 2,5 miliardi nel 2025

Obiettivo ridurre la spesa privata a carico dei cittadini

Obiettivo ridurre la spesa privata a carico dei cittadini

Chelli: ‘Cala la spesa sanitaria nel 2023 e aumenta il carico per le famiglie’

Pro Vita, con la Ru-486 si velocizza l’omicidio del nascituro

Azienda ospedaliero universitaria Marche tra i migliori ospedali

A Milano la Convention Anmco per ottimizzare le terapie