Multicenter exploration of specialist palliative care in patients with left ventricular assist devices - a retrospective study

被引：0

作者：

Tenge, Theresa ^{[1
,2
,3
,4
]}

Shahinzad, Shaylin ^{[3
,4
]}

Meier, Stefan ^{[1
,2
]}

Schallenburger, Manuela ^{[3
,4
]}

Batzler, Yann-Nicolas ^{[3
,4
]}

Schwartz, Jacqueline ^{[3
,4
]}

Coym, Anja ^{[5
]}

Rosenbruch, Johannes ^{[6
]}

Tewes, Mitra ^{[7
]}

Simon, Steffen T. ^{[8
,9
,10
]}

Roch, Carmen ^{[11
]}

Hiby, Ute ^{[12
]}

Jung, Christian ^{[2
,13
]}

Boeken, Udo ^{[2
,14
]}

Gaertner, Jan ^{[15
,16
]}

Neukirchen, Martin ^{[1
,2
,3
,4
]}

机构：

[1] Heinrich Heine Univ Duesseldorf, Med Fac, Dept Anesthesiol, Dusseldorf, Germany

[2] Heinrich Heine Univ Duesseldorf, Univ Hosp Duesseldorf, Dusseldorf, Germany

[3] Heinrich Heine Univ Duesseldorf, Univ Hosp Duesseldorf, Med Fac, Interdisciplinary Ctr Palliat Med, Moorenstr 5, D-40225 Dusseldorf, Germany

[4] Heinrich Heine Univ Duesseldorf, Univ Hosp Duesseldorf, Ctr Integrated Oncol Aachen Bonn Cologne Duesseldo, Moorenstr 5, D-40225 Dusseldorf, Germany

[5] Univ Med Ctr Hamburg Eppendorf, Dept Oncol Hematol & Bone Marrow Transplant, Palliat Care Unit, Hamburg, Germany

[6] Ludwig Maximilians Univ Munchen, LMU Univ Hosp, Dept Palliat Med, Munich, Germany

[7] Univ Duisburg Essen, Univ Hosp Essen, Dept Palliat Med, Essen, Germany

[8] Univ Cologne, Dept Palliat Med, Cologne, Germany

[9] Univ Cologne, Fac Med, Ctr Integrated Oncol Aachen Bonn Cologne Duesseldo, Cologne, Germany

[10] Univ Cologne, Univ Hosp, Cologne, Germany

[11] Univ Hosp Wuerzburg, Interdisciplinary Ctr Palliat Med, Wurzburg, Germany

[12] RHON Klinikum AG, Campus Bad Neustadt, Bad Neustadt an der Saale, Germany

[13] Heinrich Heine Univ Duesseldorf, Med Fac, Dept Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany

[14] Heinrich Heine Univ Duesseldorf, Med Fac, Dept Cardiac Surg, Dusseldorf, Germany

[15] Palliat Care Ctr Basel, Basel, Switzerland

[16] Univ Basel, Dept Clin Res, Basel, Switzerland

来源：

BMC PALLIATIVE CARE | 2024年 / 23卷 / 01期

关键词：

Palliative medicine; Heart failure; Heart-assist devices; Quality of life; Retrospective studies; Multicenter study; HEART-FAILURE; TRANSPLANT; HOSPICE; LIFE; END; CONSULTATION; IMPLANTATION; EXPERIENCE; BRIDGE; PHASE;

D O I：

10.1186/s12904-024-01563-8

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. Methods We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. Results In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3-50.3 months). Median duration between consultation and death was seven days (IQR 3-28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p < 0.001; DNR before: n = 20, after: n = 28, p < 0.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3-6); first contact: median 9 (IQR 6-10); p < 0.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit. Conclusions This largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo.

引用

页数：9