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A intervenção da medicina paliativa na insuficiência cardíaca : revisão sistemática da literatura
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Resumo(s)
Introdução: A insuficiência cardíaca (IC) é uma doença crónica debilitante, que afeta mais de 26 milhões de pessoas mundialmente. Está associada a sofrimento físico, psicológico, social e espiritual, com necessidade de hospitalizações recorrentes, pelo que os cuidados paliativos (CP) têm um papel fundamental no alívio sintomático e de suporte emocional dos doentes e seus familiares/cuidadores. Apesar de diversas recomendações internacionais para a realização de CP em doentes terminais, a realidade é que a referenciação destes doentes à medicina paliativa é escassa. O objetivo desta revisão é avaliar o impacto da intervenção paliativa em doentes com IC, contribuindo para uma maior consciencialização desta problemática.
Material e métodos: Pesquisa de artigos publicados nas bases de dados MEDLINE, Cochrane Library e EMBASE, publicados entre 1 de junho de 2012 e 1 de junho de 2022, tendo sido incluídos os estudos que compararam intervenções paliativas com o tratamento convencional, em doentes com IC. Os principais parâmetros analisados foram a qualidade de vida (QDV), burden dos sintomas, status de saúde/funcional, depressão/ansiedade e reinternamentos hospitalares.
Resultados: Foram incluídos 11 estudos, num total de 6813 participantes com uma idade média de 71 anos. Os estudos foram bastante heterogéneos no que diz respeito à metodologia, estádio da doença, comorbilidades, caraterísticas da intervenção paliativa, instrumentos de avaliação e outcomes. A maioria dos estudos demonstraram uma melhoria significativa da QDV, sintomatologia depressiva/ansiogénica e satisfação do doente com a intervenção paliativa, comparativamente com os tratamentos convencionais. Já a evidência de alívio do burden dos sintomas, aumento do status de saúde/funcional ou menor recorrência aos serviços de saúde não foi tão robusta. A análise de outros parâmetros revelou não existirem diferenças significativas entre a atuação paliativa e os cuidados habituais.
Conclusão: As intervenções de caráter paliativo parecem, de um modo geral, ser eficazes na gestão de doentes com IC, tendo demonstrado resultados promissores e que devem ser testados em ensaios futuros.
Introduction: Heart failure (HF) is a debilitating chronic disease, that affects over 26 million people worldwide. It is associated with physical, psychological, social, and spiritual suffering, and the need for recurrent hospitalizations. Palliative care (PC) has a fundamental role providing symptomatic relief and emotional support for patients and their families/caregivers. Despite several international recommendations for a PC integrative approach in terminally ill patients, there is a scarce referral of these patients to palliative medicine. The aim of this review is to evaluate the impact of palliative intervention in patients with HF, for greater awareness of this problem. Material and methods: Search of articles published in the MEDLINE, Cochrane Library, and EMBASE databases, published between June 1, 2012, and June 1, 2022, including studies that compare palliative interventions with usual care (UC), in patients with HF. The main symptoms evaluated were quality of life (QOL), symptom burden, health/functional status, depression/anxiety, and hospital readmissions. Results: 11 studies were included, with a total of 6813 participants and a mean age of 71 years. The studies were quite heterogeneous in terms of methodology, stage of the disease, comorbidities, characteristics of the palliative intervention, assessment instruments, and outcomes. Most studies demonstrated a significant improvement in QOL, depressive/anxiogenic symptoms, and patient satisfaction with the palliative intervention compared to UC. On the other hand, the evidence of symptom burden relief, enhanced health/functional status, or lower need for healthcare services was not so robust. The analysis of other parameters revealed no significant differences between PC and UC. Conclusion: Globally, the PC intervention seems efficient in HF management, showing promising results that should be tested in further trials.
Introduction: Heart failure (HF) is a debilitating chronic disease, that affects over 26 million people worldwide. It is associated with physical, psychological, social, and spiritual suffering, and the need for recurrent hospitalizations. Palliative care (PC) has a fundamental role providing symptomatic relief and emotional support for patients and their families/caregivers. Despite several international recommendations for a PC integrative approach in terminally ill patients, there is a scarce referral of these patients to palliative medicine. The aim of this review is to evaluate the impact of palliative intervention in patients with HF, for greater awareness of this problem. Material and methods: Search of articles published in the MEDLINE, Cochrane Library, and EMBASE databases, published between June 1, 2012, and June 1, 2022, including studies that compare palliative interventions with usual care (UC), in patients with HF. The main symptoms evaluated were quality of life (QOL), symptom burden, health/functional status, depression/anxiety, and hospital readmissions. Results: 11 studies were included, with a total of 6813 participants and a mean age of 71 years. The studies were quite heterogeneous in terms of methodology, stage of the disease, comorbidities, characteristics of the palliative intervention, assessment instruments, and outcomes. Most studies demonstrated a significant improvement in QOL, depressive/anxiogenic symptoms, and patient satisfaction with the palliative intervention compared to UC. On the other hand, the evidence of symptom burden relief, enhanced health/functional status, or lower need for healthcare services was not so robust. The analysis of other parameters revealed no significant differences between PC and UC. Conclusion: Globally, the PC intervention seems efficient in HF management, showing promising results that should be tested in further trials.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Cuidados paliativos Insuficiência cardíaca Qualidade de vida