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  1. Article ; Online: Ten Questions and Some Reflections about Palliative Care in Advanced Heart Failure Patients

    Massimo Romano’

    Journal of Clinical Medicine, Vol 11, Iss 6933, p

    2022  Volume 6933

    Abstract: Heart failure is a clinical syndrome with increasing prevalence, high morbidity and mortality. It is characterized by high symptom burden, poor quality of life and high economic costs. This implies that the heart failure (HF) patients who receive ... ...

    Abstract Heart failure is a clinical syndrome with increasing prevalence, high morbidity and mortality. It is characterized by high symptom burden, poor quality of life and high economic costs. This implies that the heart failure (HF) patients who receive palliative care (PC) have needs similar to cancer patients, but which are often unmet. This paper analyzes the main unresolved issues regarding the relationship between HF patients and the referral to an early PC program. These issues are presented as ten questions related to which patients should be admitted to PC and at what stage of their disease. Furthermore, the barriers opposing to referral to PC, the role of cardiologists and PC physicians within the care team, the gap between the scientific societies’ suggestions and the real world, the right time to promote patients’ awareness and shared decision making, regarding prognosis, end of life wishes and choices, with reference also to cardiac implantable devices’ deactivation, are discussed. These unresolved questions support the need to reevaluate programs and specific models in achieving equal access to palliative care interventions for HF patients, which is still mainly offered to patients with cancer.
    Keywords palliative care ; supportive care ; heart failure ; end of life care ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2022-11-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Barriers to Early Utilization of Palliative Care in Heart Failure

    Massimo Romanò

    Healthcare, Vol 8, Iss 1, p

    A Narrative Review

    2020  Volume 36

    Abstract: Palliative care is indicated in patients with heart failure since the early phases of the disease, as suggested by international guidelines. However, patients are referred to palliative care very late. Many barriers could explain the gap between the ... ...

    Abstract Palliative care is indicated in patients with heart failure since the early phases of the disease, as suggested by international guidelines. However, patients are referred to palliative care very late. Many barriers could explain the gap between the guidelines’ indications and clinical practice. The term palliative is perceived as a stigma by doctors, patients, and family members because it is charged with negative meanings, a poor prognosis, and no hope for improvement. Many authors prefer the term supportive care, which could facilitate a discussion between doctors, patients, and caregivers. There is substantial variation and overlap in the meanings assigned to these two terms in the literature. Prognosis, as the main indication to palliative care, delays its implementation. It is necessary to modify this paradigm, moving from prognosis to patients’ needs. The lack of access to palliative care programs is often due to a lack of palliative care specialists and this shortage will be greater in the near future. In this study, a new model is proposed to integrate early over the course of the disease the palliative care (PC) specialist in the heart failure team, allowing to overcome the barriers and to achieve truly simultaneous care in the treatment of heart failure (HF) patients.
    Keywords palliative care ; supportive care ; heart failure ; end of life ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2020-02-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: The Role of Palliative Care in the Cardiac Intensive Care Unit

    Massimo Romano’

    Healthcare, Vol 7, Iss 1, p

    2019  Volume 30

    Abstract: In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly ... ...

    Abstract In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden and mortality rate and an increased length of stay. In this context, palliative care programs, including withholding/withdrawing life support treatments or the deactivation of implanted cardiac devices, are frequently needed, according to the specific guidelines of scientific societies. However, the implementation of these recommendations in clinical practice is still inconsistent. In this review, we analyze the reasons for this gap and the main cultural changes that are required to improve the care of patients with advanced illness.
    Keywords intensive care unit ; cardiac intensive care unit (CICU) ; palliative care ; end of life care ; withdrawing treatment ; withholding treatment ; heart failure ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2019-02-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy

    Massimo Romanò / Sabina Oldani / Valter Reina / Michele Sofia / Claudia Castiglioni

    Healthcare, Vol 10, Iss 1031, p

    2022  Volume 1031

    Abstract: Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. ...

    Abstract Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [ n = 78], heart disease [ n = 55], and lung disease [ n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10–20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2–3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice ( n = 133), at home ( n = 9), or after family-requested transfer to an emergency department ( n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients.
    Keywords palliative care ; end-of-life care ; supportive care ; hospice ; non-cancer illness ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2022-06-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Takotsubo Cardiomyopathy as an Early Complication of Drug-Induced Suicide Attempt

    Massimo Romanò / Federica Zorzoli / Roberta Bertona / Rosvaldo Villani

    Case Reports in Medicine, Vol

    2013  Volume 2013

    Abstract: Takotsubo cardiomyopathy typically presents in menopausal women following episodes of intense physical or mental stress. To our knowledge, the literature contains only two documented cases of Takotsubo cardiomyopathy arising following a suicide attempt, ... ...

    Abstract Takotsubo cardiomyopathy typically presents in menopausal women following episodes of intense physical or mental stress. To our knowledge, the literature contains only two documented cases of Takotsubo cardiomyopathy arising following a suicide attempt, neither of which involved pharmaceutical poisoning. Here, however, we document the case of a young male patient with borderline personality disorder and a clinical and angiographic presentation compatible with Takotsubo cardiomyopathy arising following a suicide attempt by voluntary drug intoxication (risperidone, barbiturates, and benzodiazepine). The potential pathophysiological mechanisms behind this unusual clinical picture are discussed.
    Keywords Medicine ; R
    Language English
    Publishing date 2013-01-01T00:00:00Z
    Publisher Hindawi Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: A case of pulmonary hyperinflation in chronic heart failure

    Claudio Di Gioia / Giuseppe De Simone / Antonio Di Sorbo / Gabriele Borzillo / Giovanni D’Addio / Alessandro Ciarimboli / Ilernando Meoli / Massimo Romano / Andrea Bianco

    Clinical Management Issues, Vol 5, Iss 2, Pp 55-

    role of diuretic therapy and cardiorespiratory rehabilitation

    2011  Volume 60

    Abstract: Persistent dyspnoea during daily activities is commonly observed in patient with chronic heart failure (CHF) despite optimised pharmacological therapy. In CHF patients diuretics are essential for symptomatic treatment when fluid overloads with consequent ...

    Abstract Persistent dyspnoea during daily activities is commonly observed in patient with chronic heart failure (CHF) despite optimised pharmacological therapy. In CHF patients diuretics are essential for symptomatic treatment when fluid overloads with consequent pulmonary congestion or peripheral oedema. Appropriate use of diuretics is key element versus other drugs used for the success of the treatment of HF. Conversely, the inappropriate use of high doses of diuretics can cause adverse effects as electrolyte and fluid depletion, hypotension and hyperazotemia. Dyspnoea and fatigue, in patients with stable HF, are not related only to fluid overload and/or fluid retention but likely other mechanisms are linked to symptoms increase. These patients at the end of a rehabilitative treatment take less diuretic doses than during the period before the rehabilitative treatment, so reducing the principal adverse effects and improving the symptoms. In these patients in absence of venous congestion but in presence of an increase of symptoms augmenting diuretic drugs is not useful: it is very useful, instead, to undergo these patients a rehabilitative treatment because other mechanisms are linked to symptoms increase. In fact, in our report the predominant mechanism determining the increase in dyspnoea is likely related to an increase in physiological dead space.
    Keywords Diuretics ; Chronic heart failure ; Dyspnoea ; Cardiopulmonary rehabilitation ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2011-06-01T00:00:00Z
    Publisher SEEd
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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