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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DG Palliativmedizin]. Med Klin Intensivmed Notfmed 2023; 118:14-38. [PMID: 37285027 PMCID: PMC10244869 DOI: 10.1007/s00063-023-01016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
The integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S3 guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität und Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90471, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Deutschland
| | - Bernd Schucher
- Abteilung Pneumologie, LungenClinic Großhansdorf, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Universitätsmedizin Essen Ruhrlandklinik, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Universität zu Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Xu T, Sun W, Zhao H, Wang X, Yuan Q, Zhang X, Mao S, Zhang X, Zhao M, Sheng Z, Zhang M, Huang M, Ji N. Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2329-2341. [PMID: 36164549 PMCID: PMC9509010 DOI: 10.2147/copd.s376909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is considered as severe exacerbations. Readmission for severe exacerbations is a crucial event for COPD patients. However, factors associated with readmission for severe exacerbations are incomplete. The study aimed to investigate different characteristics between the severe and non-severe exacerbation groups. Patients and Methods Patients hospitalized for severe AECOPD were included in multi-centers, and their exacerbations in next 12 months after discharge were recorded. According to exacerbations, patients were separated into the severe-exacerbation group and the non-severe exacerbation group. Propensity-score matching (PSM) and multivariable analyses were performed to compare the baseline characteristics of two groups. The Hosmer-Lemeshow test and receiver operating characteristic curve were applied to evaluate how well the model could identify clusters. Results The cohort included 550 patients with severe AECOPD across 27 study centers in China, and 465 patients were finally analyzed. A total of 41.5% of patients underwent readmission for AECOPD within 1 year. There were no significant differences in baseline characteristics between groups after PSM. Severe exacerbations in the 12 months were related to some factors, eg, the duration of COPD (13 vs 8 years, P<0.001), the COPD Assessment Test (CAT) score (20 vs 17, P<0.001), the blood eosinophil percentage (1.5 vs 2.0, P<0.05), and their inhaler therapies. Patients readmitted with AECOPD had a longer time of diagnosis (≥9 years), more symptoms (CAT ≥10), and lower blood eosinophils (Eos <2%). A clinical model was derived to help identify patients at risk of readmission with severe exacerbations. Conclusion These analyses confirmed the relevance of COPD at admission with future severe exacerbations. A lower blood eosinophils percentage appears to be related to readmission when combined with clinical history. Further studies are needed to evaluate whether this study can predict the risk of exacerbations.
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Affiliation(s)
- Tingting Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wei Sun
- Department of Respiratory and Critical Care Medicine, Xishan People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Hongqing Zhao
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Wuxi, People's Republic of China
| | - Xinmin Wang
- Department of Respiratory and Critical Care Medicine, Shuyang Hospital of Traditional Chinese Medicine, Suqian, People's Republic of China
| | - Qi Yuan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xijie Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shan Mao
- Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing, People's Republic of China
| | - Xiuwei Zhang
- Department of Respiratory and Critical Care Medicine, Nanjing Jiangning Hospital, Nanjing, People's Republic of China
| | - Mingming Zhao
- Department of Respiratory and Critical Care Medicine, Nanjing Gaochun People's Hospital, Nanjing, People's Republic of China
| | - Zebo Sheng
- Department of Respiratory and Critical Care Medicine, Changshu First People's Hospital, Suzhou, People's Republic of China
| | - Mingshun Zhang
- Department of Immunology, Nanjing Medical University, Nanjing, People's Republic of China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ningfei Ji
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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