How Medicine Has Changed the End of Life for Patients With Cardiovascular Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:70

Review

Warraich, Haider J.^1,2  Hernandez, Adrian F.^1,2  Allen, Larry A.³ 

[1] Duke Univ, Med Ctr, Dept Med, Div Cardiol, 2301 Erwin Rd,DUMC 3485, Durham, NC 27713 USA

[2] Duke Clin Res Inst, Durham, NC 27705 USA

[3] Univ Colorado, Sch Med, Div Cardiol, Denver, CO USA

关键词: disability;    disparities;    heart failure;    hospice;    left ventricular assist device;    palliative care;   

DOI  :  10.1016/j.jacc.2017.07.735

来源: Elsevier

【 摘 要 】

Advances in medicine have changed how patients experience the end of life. With longer life spans, there has also been an increase in years lived with disability. The clustering of illnesses in the last years of life is particularly pronounced in patients with cardiovascular disease. At the end of life, patients with cardiovascular disease are more symptomatic, less likely to die at home, and less likely to receive high-quality palliative care. Social determinants have created widening disparities in end-of-life care. The increasing complexity and duration of care have resulted in an epidemic of caregiver burden. Modern medical care has also resulted in new ethical challenges, for example, those related to deactivation of cardiac devices, such as pacemakers, defibrillators, and mechanical circulatory support. Recommendations to improve end-of-life care for patients with cardiovascular disease include optimizing metrics to assess quality, ameliorating disparities, enhancing education and research in palliative care, overcoming disparities, and innovating palliative care delivery and reimbursement. (J Am Coll Cardiol 2017;70:1276-89) (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

Free