报告发现，心脏病患者未充分利用姑息治疗

Palliative care – which can include changes to medication – can alleviate symptoms and improve quality of life for people with heart disease. 但这种做法没有得到充分利用, 尤其是在代表性不足的种族和族裔群体中, 根据一份新的报告.

The 科学声明 from the 美国心脏协会 reviews current evidence on the benefits and risks of cardiovascular and palliative medications, providing guidance to health care professionals on how to incorporate palliative therapies into a multidisciplinary, holistic treatment approach that emphasizes shared decision-making and goal-focused care. It published Monday in Circulation: Cardiovascular Quality and Outcomes.

"Given the complexities of medication management in people with heart disease, 提倡以团队为基础的方法,包括心脏病专家, 初级和姑息治疗卫生专业人员, 写作小组主席博士. 凯瑟琳·E. 迪·帕洛说 线上电子游戏飞禽走兽发布会上. She is senior director of Transitional Care Excellence at Montefiore Medical Center and an assistant professor of medicine at Albert Einstein College of Medicine in New York City.

Palliative care complements medical care by providing relief from the symptoms and stress of a serious illness. 它不是治疗疾病本身的方法.

Studies have shown that integrating palliative care into a person's evidence-based treatment plan can improve quality of life, 减少抑郁和焦虑, improve spiritual well-being and lower the risk for hospital readmission for people with advanced heart disease. However, 可能很少有人会接受这种治疗, 哪些可以在心血管疾病的任何阶段提供. 例如，报告引用 a study 2016年发表在《线上娱乐电子游戏网站》(JAMA Cardiology)上的一项研究显示，美国只有不到20%的心脏病患者.S. veterans with end-stage heart disease received palliative care within a year of hospitalization.

根据新的声明, 姑息治疗可能使所有心血管疾病患者受益, 包括冠心病, 心脏瓣膜病, pulmonary arterial hypertension and heart failure – conditions that significantly reduce quality of life, 需要持续治疗, 通常是进行性的并且与高死亡率相关.

But there are disparities in who gets referred, according to the statement. People with heart failure who receive referrals for palliative care are predominantly white, have higher socioeconomic status and are more likely to receive their care at academic medical centers. People from underrepresented racial and ethnic groups are less likely to receive palliative care, 导致较差的结果和早期死亡的风险增加.

Medication management is a major component of palliative care that can greatly relieve symptoms. This may include cardiovascular medications – such as diuretics to manage fluid retention in people with heart failure – as well as therapies to manage depression, pain, 呼吸困难和恶心.

因为一个人的情况可能会迅速变化, the statement emphasized the need for ongoing discussions with health care professionals to ensure treatment plans reflect the individual's preferences and priorities. It's also important for health professionals to evaluate and communicate the risks and benefits of medications and how long it may take for them to work.

"It is critical for patients to be fully informed about their diagnosis and how medication management may change throughout the disease progression so they have ample time to set and share their goals,迪·帕洛说. "These goals often include reducing symptoms such as shortness of breath, 疲劳和疼痛, 以及改善睡眠, 情绪和食欲."

Palliative care may also include changes to medications by tapering or withdrawing them if, 例如, the time it would take to benefit from the medication is longer than the person's life expectancy or if the person is taking so many medications they risk side effects. 在其他情况下, it may be appropriate to reduce the dose or switch to a new medication based on how the person responds to it.