Study On The Factors Affecting Long-term Prognosis Of Patients With Advanced Heart Failure And The Care Perception And Palliative Care Cognition Of Cardiologist

Part Ⅰ Factors Affecting Long-term Prognosis in Patients with Dilated Cardiomyopathy with Severely Reduced Ejection FractionObjective:To explore the related factors of long-term survival of patients with dilated cardiomyopathy with severely reduced left ventricular ejection fraction(LVEF)under standardized treatment.Methods:The 59 patients with dilated cardiomyopathy with an LVEF below 35%who received standardized treatment from 1992 to 2011 were included from the Peking Union Medical College Echocardiography Database.The clinical data,consultation information,and prognosis of the patients were collected for analysis.Mid-term follow-up was performed in June 2014 The final survival follow-up was performed in June 2018.Results:The 35 patients(59.3%)of the New York Heart Association(NYHA)cardiac function grade Ⅲ to Ⅳ,the average left ventricular end-diastolic diameter was(72±10)mm,and biplanar LVEF was(25%±9%),angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor antagonist(ACEI/ARB)use rate was 86.4%when enrolled,and the dose compliance rate during follow-up was 30.6%(15/49);B-blockers were used at a rate of 88.1%when enrolled,and the rate reached target during follow-up was 25.0%(13/52);spironolactone was used at 67.8%;assisted device implantation(heart resynchronization treatment,implantable cardioverter defibrillator and cardiac resynchronization therapy defibrillator)utilization rate was 27.1%.The median survival time was 83(40,138)months,the shortest survival time was 9 months,the longest was 296 months(about 25 years),and 46.3%(19/41)of patients died of cardiogenic shock.Sudden death occurred in 19.5%(8/41)of patients.Survival analysis showed that the dose of β-blockers reached the target(HR:0.128,95%CI:0.037-0.447,P=0.001)and regular follow-up(HR:0.222,95%CI:0.071-0.691,P=0.009)were related to long-term survival.Conclusions:Patients with dilated cardiomyopathy with LVEF below 35%can achieve long-term survival after standardized treatment,and the regular follow-up is related to long-term survival.Part Ⅱ A Study on the Feelings of Cardiologists in Caring for Patients with Advanced Heart Failure and Their Cognition of Palliative CareObjective:To describe the feelings of cardiologists in tertiary comprehensive hospitals caring for patients with advanced heart failure,as well as their understanding and feelings towards palliative careMethods:Semi-structured interviews were conducted among 19 cardiologists with experiences in caring for patients with advanced heart failure at Beijing Union Medical College Hospital.Thematic analysis was used to analyze the data.Results:Seven themes were extracted.Three themes were involved in the feelings of the care of cardiologists:1)The cardiologists generally had negative feelings when caring for patients with advanced heart failure:negative feelings caused by the difficulty of disease reversal,stubborn pain symptoms,and facing emotions;2)Complex and contradictory feelings,including conflicting feelings about sudden death,complex feelings about long-term follow-up,and dilemma in medical decision-making processes;3)Cardiologists had less positive feelings and are mainly related to improved prognosis.Four themes were involved in the understanding and feelings of palliative care by cardiologists:1)Cardiologists generally lacked awareness of palliative care;2)They had positive feelings for palliative care and looked forward to receiving palliative care for patients with advanced heart failure;3)They worried about the conflict between palliative care and heart failure treatment,and worried that family members may not accept the concept of palliative care.4)They hoped to received palliative care training.Conclusions:Cardiologists generally had varying degrees of negative feelings in the process of caring for patients with advanced heart failure,and some complex and contradictory feelings.Cardiologists generally lacked awareness of palliative care,however,they had a strong desire to receive training in palliative care.