Current Trends and Possibilities of Providing Medical Palliative Care in Chronic Heart Failure

Malnutrition is one of the most common disorders observed in patients who are being treated for various diseases. In cancer patients with a palliative profile, compared with patients without malignant neoplasms, anemia, lymphopenia, decreased glomerular filtration rate were significantly more often detected, and a tendency to lower albumin levels was revealed. There was a significant decrease in PNI, BMI, shoulder circumference, thickness of the skin‑fat fold of the scapula and shoulder, and a tendency to reduce lean body weight in patients with palliative malignancies. The logistic regression analysis revealed the relationship between the presence of a malignant tumor in palliative patients and the presence of trophic status disorders: PNI (β = –0.37, p = 0.021), weight (β = –0.41, p = 0.001), BMI (β = –0.36, p = 0.001), shoulder circumference (β =–0.65, p = 0.001), thickness of the scapular skin‑fat fold (β = –0.66, p = 0.001).

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Association of malignant neoplasms and impaired nutritional status in patients receiving palliative care

Курченкова

Важенин

Harlamova

et al. 2021

Malignant Tumours

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Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region

Rubanenko,

Skripnik,

Matuchina

et al. 2024

Kardiologiia

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Aim. To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.Material and methods. A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.Results. 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.Conclusion. Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

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Current Trends and Possibilities of Providing Medical Palliative Care in Chronic Heart Failure

Cited by 2 publications

References 34 publications

Association of malignant neoplasms and impaired nutritional status in patients receiving palliative care

Association of malignant neoplasms and impaired nutritional status in patients receiving palliative care

Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region

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