Risultati per: I farmaci da utilizzare nelle cure palliative

I progetti in corso all’Humanitas: dai modelli 3D agli organoidi fino all’intelligenza artificiale

Annals of Internal Medicine, Ahead of Print.

‘È un primo passo, ma da solo non basta’

11mila bimbi necessitano di assistenza specialistica,coperto 25%

Le nuove prestazioni erano attese da quasi otto anni e cioè da quando era comparsa la prima versione del tariffario poi sempre rinviato per il nodo risorse

Sitd, crescita fenomeni preoccupa soprattutto tra i giovani

Int, esame molecolare per garantire farmaci personalizzati

Medicinali più consumati sono per cuore, intestino e sangue

Circulation, Volume 150, Issue Suppl_1, Page A4140984-A4140984, November 12, 2024. Introduction:Heart failure (HF) is a prevalent medical condition, affecting approximately 6.7 million Americans. Patients with HF frequently experience comorbidities such as depression and anxiety, which can lead to diminished quality of life. According to the World Health Organization (WHO), palliative care may be beneficial for these patients in addressing their complex physical, mental, and social needs. Therefore, an assessment of palliative care involvement in HF patients is warranted to determine its impact on improving quality of life, alleviating symptoms such as dyspnea, depression, and anxiety.Hypothesis:The aim is to assess the impact of palliative care interventions on the quality of life, dyspnea, anxiety, and depression in patients with HF.Methods:A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, Embase, and Web of Science databases from their inception until March 2024. Studies reporting on the impact of palliative care interventions on the quality of life of patients with HF were included. The primary outcome was the effect on quality of life, while the effects on dyspnea, depression, and anxiety were secondary outcomes. Data from the studies were pooled using RevMan V5.4, and changes in the mean difference from baseline and confidence intervals (CI) were calculated for each outcome.Results:The meta-analysis included eleven studies, predominantly randomized controlled trials, with a total of 1662 participants, 812 of whom received palliative care interventions. The analysis revealed a significant improvement in the mean change from baseline within the intervention group compared to usual care. Specifically, the quality of life showed a mean difference change from the baseline of 1.35 (95% CI: 0.88 to 1.82), anxiety improved with a mean difference change from baseline of 0.30 (95% CI: 0.03 to 0.58), and dyspnea showed a mean difference change from baseline of 1.0 (95% CI: 0.74 to 1.26). However, there was no significant difference in the mean change from baseline for depression between both groups.Conclusion:Palliative care interventions are associated with significant improvements in quality of life, anxiety, and dyspnea in patients with heart failure compared to usual care. However, there is no significant impact on depression. These findings support the integration of palliative care into the management of heart failure patients to enhance their overall well-being.

Circulation, Volume 150, Issue Suppl_1, Page A4116558-A4116558, November 12, 2024. Background:Palliative care (PC) engagement can improve quality of life, reduce hospital costs, and enhance symptom control for individuals with heart failure (HF). For certain HF patients, PC can address symptoms and improve quality of life. However, referrals to PC often occur late, delaying benefits.Hypothesis:We hypothesize that a standardized recommendation for inpatient PC consultation will increase PC consultation rates and improve 30-day readmission without an impact on 30-day mortality rates.Methods:This interrupted time series study focused on high-risk HF patients at Atrium Health Wake Forest Baptist. The cohort included patients in the Golden Hearts Program, which is a local program to identify HF patients at elevated risk for 30-day readmissions and to accelerate resources to support their transitions. Baseline data were from patients 5 months before September 1, 2023, and the intervention group were from patients 5 months afterward. A standardized message recommending inpatient PC consultation was sent to attending physicians for patients with ESCAPE scores ≥4. Recommendations were also discussed at multidisciplinary rounds with senior residents. The primary outcomes were inpatient palliative care consultation and discharge to Hospice. Secondary outcomes were 30-day readmissions and 30-day mortality. Outcome measures were assessed post-discharge using Chi-square and T-test analyses.Results:The baseline group had 203 patients; the intervention group had 213. Post-intervention, PC consultation rates decreased from 12.3% to 8% (p=0.19), Discharge to hospice decreased from 2% to 0.9% (p=0.05), 30-day mortality decreased (8.4% vs 7%, p=0.74), and 30-day readmission dropped from 23.6% to 15% (p=0.04). The average length of stay remained 5.7 days in both groups. Limitations included provider buy-in and a limited time period.Conclusion:Though the intervention aimed at targeted PC consult recommendations for advanced HF patients led to reduced 30-day readmissions, there was a not a statistically significant impact on palliative care consultation or mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4134569-A4134569, November 12, 2024. Background and purpose:Patients with heart failure (HF) have a high burden of palliative care needs (PCN) and a worse prognosis that is not lower than cancer. The Integrated Palliative Care Outcome Scale (IPOS) is a scale that evaluates PCN in illness patients, mostly in cancer.Purpose:To evaluate the PCN in hospitalized heart failure patients by IPOS and its relation with patients’ characteristics and mortality.Methodology:A cross-sectional study was conducted on 160 HF hospitalized patients in Vietnam, who were evaluated by IPOS, including questions using a 5-point Likert scale (0 [best]–4 [worst] points) about physical symptoms (10 items), emotional symptoms (4 items), and communication and practical issues (3 items). Patients were determined to have PCN if having ≥ two items with 4 points or ≥ 3 items with ≥ 3 points.Results and discussions:Mean age: 69,57 ± 11,95 years, male: 68.75%, mean LVEF: 44.19 ±16.11%, and NT-proBNP level: 9107.3 ± 30459.1ng/L, the percentage of patients with PCN was 59.38%. The majority of patients had moderate levels (2 points) of dyspnea (38.13%), weakness (35.0%), and low levels (0 or 1 point) of other physical symptoms. Moderate levels (2 points) were the most common in the patient’s anxiety (43.13%) and family anxiety (51.25%), feeling at peace (40.0%), sharing feelings (55.0%), enough information (45.0%), and practical issue (45.0%). Having PCN was significantly correlated to the duration of heart failure, eGFR, and usage of intravenous medication but not related to heart failure severity (NYHA class, LVEF, NT-ProBNP level) and other characteristics (age, gender, residency, educational levels, occupation). Having PCN was independently associated with higher all-cause mortality after discharge with follow-up for one year (P = 0.037).Conclusions:Hospitalized patients with HF had multi-dimensional symptom burdens in moderate levels. PCN was not related to HF severity but correlated to duration of heart failure, eGFR, and usage of intravenous medication. Having PCN was independently associated with mortality after discharge.