在被诊断为晚期心力衰竭的患者中,所有原因死亡的危险因素:范围审查
Palvinder Kaur1, Pradeep Paul George1, Sheryl Ng Hui Xian1
1Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.
Journal of palliative medicine
|July 31, 2024
概括
识别患有晚期心力衰竭 (AdHF) 的高风险患者对于及时的息治疗至关重要. 这次审查确定了AdHF的风险因素和预后模型,旨在改善以患者为中心的护理和生存预测.
科学领域:
- 心脏病学 心脏病学
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 晚期心力衰竭 (AdHF) 患者的需求正在不断发展,需要更好的风险分层,以便及时转诊息治疗.
- 有限的预后模型存在,专门用于末期心力衰竭 (HF) 种群.
- 准确的风险评估促进了个性化,以患者为中心的护理,并改善了结果.
研究的目的:
- 在ADHF患者中确定与高达三年全因死亡率 (ACM) 相关的风险因素.
- 描述在ADHF群体中开发或验证的预后模型.
- 提供及时的息护理转诊信息,并加强患者管理策略.
主要方法:
- 根据Arksey,O'Malley和Levac框架进行了范围审查.
- 搜索了多个数据库 (Medline,EMBASE,PubMed,CINAHL,Cochrane,科学网) 和灰色文献 (2010年1月至2020年9月).
- 包括成人 (≥18岁) 患有ADHF (NYHA类III/IV,AHA/ACC阶段D) 的初级研究,使用多变量分析评估ACM的风险因素.
主要成果:
- 在65篇文章中 (低至中等偏差) 确定了多达三年的ACM和预后模型的167个风险因素.
- 研究主要来自西方/欧洲队列,在急性护理环境中,并来自临床试验.
- 十个预后模型显示了可接受的性能 (AUC:0.71-0.81),其中MELD-XI和ADHF/proBNP模型显示了最高的短期ACM歧视 (AUC:0.81).
结论:
- 对于ADHF患者有几种风险因素和预后模型可用,尽管研究主要以西方为中心和急性护理为重点.
- MELD-XI和ADHF/proBNP模型显示出预测AdHF中短期ACM的前景.
- 需要进一步的研究来开发和验证反映当前ADHF管理环境的预后模型,以便及时整合息护理.
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