Screening and Initiating Supportive Care in Patients With Heart Failure

Frontiers in Cardiovascular Medicine

article

Quynh Nguyen¹  Kaiming Wang¹  Anish Nikhanj¹  Dale Chen-Song¹  Ingrid DeKock²  Justin Ezekowitz¹  Mehrnoush Mirhosseini²  Bibiana Cujec¹  Gavin Y. Oudit¹ 

[1] Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta;Division of Palliative Care Medicine, Department of Oncology, University of Alberta

关键词: heart failure;    supportive care;    palliative care;    KCCQ;    quality of life;   

DOI  :  10.3389/fcvm.2019.00151

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF. Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population. Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.

【 授权许可】

CC BY