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Review| Volume 34, ISSUE 7, P914-924, July 2018

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New Dimensions in Palliative Care Cardiology

  • Michael Slawnych
    Correspondence
    Corresponding author: Dr Michael Slawnych, South Health Campus, 4448 Front St SE, Calgary, Alberta T3M 1M4, Canada. Tel.: +1-403-956-3899; fax: +1-403-956-1482.
    Affiliations
    Libin Cardiovascular Institute and Division of Palliative Care, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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Published:April 05, 2018DOI:https://doi.org/10.1016/j.cjca.2018.03.018

      Abstract

      The landscape of patient care at the beginning of the 19th century was dramatically different than it is today. With few good treatment options, illness courses were generally brief. Near the end of life, patients were attended to by spiritual advisors, not health care professionals. Death typically occurred at home, surrounded by friends and family. Moving to the present time, decades of medical advances have significantly improved life expectancy. Cardiology has particularly benefited from many of these advances. Cardiac patients are initiated on optimal medication regimens. As disease burdens progress, interventions such as implantable defibrillators and cardiac resynchronization pacing systems become options for many patients. With further clinical deterioration, select patients might be candidates for ventricular assist devices and heart transplants. These advances have unquestionably improved the prognosis with advanced cardiovascular illnesses. However, they have also changed patient and family attitudes about death and dying, to the point where we have effectively “medicalized our mortality.” The importance of introducing palliative care to the cardiac patient population is now well recognized, with the major cardiovascular societies incorporating palliative care principles into their guideline and consensus statement documents. However, despite this recognition, few cardiac patients get access to palliative care and other resources such as hospice. In this article the existing literature on this topic is reviewed and opportunities for developing and fostering a more collaborative relationship between the disciplines of cardiology and palliative care are discussed.

      Résumé

      Le paysage des soins prodigués aux patients au début du XIXe siècle différait radicalement de ce qu’il est aujourd’hui. Faute de traitements efficaces, le cours de la maladie était généralement bref. En fin de vie, ce sont des conseillers spirituels plutôt que des professionnels de la santé que l’on retrouvait au chevet du patient. Le plus souvent, le patient décédait chez lui, entouré de ses amis et de sa famille. En revanche, aujourd’hui, les progrès de la médecine au cours des décennies ont permis une amélioration marquée de l’espérance de vie. La cardiologie a particulièrement bénéficié de bon nombre de ces avancées. Les patients atteints d’une cardiopathie se voient d’abord prescrire un schéma pharmacologique optimal. Lorsque la maladie progresse, des interventions comme les défibrillateurs implantables et les systèmes de resynchronisation cardiaque deviennent des options envisageables chez de nombreux patients. Lorsque la détérioration clinique se poursuit, certains patients peuvent être candidats à la pose d’un dispositif d’assistance ventriculaire ou à une transplantation cardiaque. Ces progrès ont sans conteste amélioré le pronostic des maladies cardiovasculaires à un stade avancé. Toutefois, ils ont également eu pour effet de transformer l’attitude du patient et de sa famille face à la mort, au point où nous avons bel et bien « médicalisé notre mortalité ». L’importance d’offrir des soins palliatifs à la population des patients cardiaques est à présent bien reconnue et les sociétés médicales s’intéressant aux maladies cardiovasculaires ont maintenant intégré les principes en la matière à leurs lignes directrices et à leurs déclarations de consensus. Toutefois, malgré cette reconnaissance, rares sont les patients cardiaques qui ont accès à des soins palliatifs et à d’autres ressources comme les maisons de fin de vie. Dans cet article, nous recensons la littérature sur cette question et analysons les possibilités de tisser et de promouvoir des liens de collaboration plus étroits entre les disciplines de la cardiologie et des soins palliatifs.
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