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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Article info
Publication history
Published online: April 05, 2018
Accepted:
March 27,
2018
Received:
November 13,
2017
Footnotes
See page 922 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
