JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases

Anzai, Toshihisa; Sato, Takuma; Izumi, Chisato; Kizawa, Yoshiyuki; Koga, Masatoshi; Nishimura, Kazuhiko; Ohishi, Mitsuru; Sakashita, Akihiro; Sakata, Yasushi; Shiga, Tsuyoshi; Takeishi, Yasuchika; Yasuda, Satoshi; Yamamoto, Kazuhide; Abe, Takahiro; Akaho, Rie; Hamatani, Yasuhiro; Hosoda, Hayato; Ishimori, Naoki; Kato, Masaya; Kinugasa, Yoshiharu; Kubozono, Takuro; Nagai, Toshiyuki; Oishi, Shogo; Okada, Katsuki; Shibata, Tatsuhiro; Suzuki, Atsushi; Suzuki, Tsuyoshi; Takagi, Masahito; Takada, Yasuko; Tsuruga, Kenkichi; Yoshihisa, Akiomi; Yumino, Dai; Fukuda, Keiichi; Kihara, Yasuki; Saito, Yoshihiko; Sawa, Yoshiki; Tsutsui, Hiroyuki; Kimura, Takeshi

doi:10.1253/circj.cj-20-1127

Cited by 25 publications

(27 citation statements)

References 292 publications

(196 reference statements)

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“…When facing the end of life, ICD therapy (especially shock therapy) is not always desired by patients or their families; therefore, the decision to deactivate the ICD therapy can be acceptable. With the overlap in the timing of publishing JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases, 4 we decided to describe the class recommendations based on the evidence level and decision-making process in this focused update. In association with ACP, we also mention the indications for ICDs in elderly patients.…”

Section: Management Of Implantable Cardioverter Defibrillators (Icds)...mentioning

confidence: 99%

“…This process needs to consider the ethics, cognitive ability of patient, etc, and judgment should be made not only by cardiologists and nurses but also based on consultation with palliative care and medical teams (including psychiatrists and psychologists); sufficient informed consent, depending on the individual situation, should be provided (Figure 1). 4 The preparation of ACP directives at the end of life plays an important role with respect to the patient's will. Of course, the content of such directives can be subsequently changed.…”

Section: Role Of Left Bundle Pacingmentioning

confidence: 99%

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JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

Nogami¹,

Kurita²,

Kusano³

et al. 2022

Journal of Arrhythmia

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Section: Management Of Implantable Cardioverter Defibrillators (Icds)...mentioning

confidence: 99%

Section: Role Of Left Bundle Pacingmentioning

confidence: 99%

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

Nogami¹,

Kurita²,

Kusano³

et al. 2022

Journal of Arrhythmia

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“…2021. 4 ) controversial. Shock therapy not only causes pain to the patient but also distresses the family members who provide care for the patient, thereby contradicting the purpose of palliative care in terminally ill patients.…”

Section: Provide Sufficient Information About Icd Therapymentioning

confidence: 99%

JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias

Nogami

Kurita

Kusano

et al. 2022

Circ J

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AVNRT atrioventricular nodal reentrant tachycardia BARC Bleeding Academic Research Consortium CBA cryoballoon ablation CIED cardiac implantable electronic device COR class of recommendation CRT cardiac resynchronization therapy CRT-D cardiac resynchronization therapy defibrillator CRT-P cardiac resynchronization therapy pacemaker CT computed tomography DAP dose-area product DAPT dual antiplatelet therapy DNAR Do Not Attempt Resuscitation DOAC direct oral anticoagulant EBM evidence-based medicine ESC European Society of Cardiology JCS GUIDELINES

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“…Oral opioids have been reported to be effective in both the long term and the short term for refractory dyspnea in patients with chronic HF [5]. Continuous intravenous/subcutaneous morphine infusion is also used in the palliative care setting for patients with end-stage HF [6]. However, the dose and duration of continuous morphine infusion have not been established for refractory dyspnea and pain relief in patients with end-stage HF.…”

Section: Introductionmentioning

confidence: 99%

“…The major adverse drug reactions (ADRs) associated with morphine, such as nausea/vomiting, constipation, respiratory depression, and drowsiness occur regardless of the dose [6,7]. Morphine is metabolized in the liver to morphine-3-glucuronide and morphine-6-glucuronide (M6G), which is excreted by the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Adverse Drug Reactions in Japanese Patients with End-Stage Heart Failure Receiving Continuous Morphine Infusion: A Single-Center Retrospective Cohort Study

Gotou

Suzuki

Shiga

et al. 2021

Drugs - Real World Outcomes

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Background Opioids have been reported to be effective for refractory dyspnea in patients with advanced heart failure (HF) in the palliative care setting. Objective The aim of this study was to evaluate the incidence of adverse drug reactions (ADRs) and their relationship with morphine dose/duration or renal insufficiency in patients with end-stage HF receiving continuous morphine infusion. Methods We retrospectively studied 38 patients with end-stage HF receiving continuous intravenous or subcutaneous morphine infusion for the relief of breathlessness between 2014 and 2019 (mean age 78 years). The endpoints were nausea/ vomiting, respiratory depression, and drowsiness, which are common morphine-related ADRs. Results Of 38 patients with end-stage HF receiving continuous intravenous/subcutaneous morphine infusion, 14 (37%) experienced ADRs. The median estimated glomerular filtration rate (eGFR) was lower in patients with than in those without ADRs (16 [range 9-48] vs. 41 [range 8-133], respectively; p = 0.011). The ADRs with the highest incidence were drowsiness (n = 13), nausea/vomiting (n =5), and respiratory depression (n =3). There were no differences in the maintenance dose or duration of morphine administration between patients with and without ADRs. A baseline eGFR of 32 mL/min/1.73 m 2 was a good cutoff value for ADR prediction (sensitivity 86%, specificity 96%). A baseline eGFR < 32 mL/min/1.73 m 2 was significantly associated with the occurrence of morphine-related ADRs (odds ratio 6.63, 95% confidence interval 1.19-37.01). Conclusions Our results showed that 37% of patients with end-stage HF receiving continuous intravenous/subcutaneous morphine infusion experienced ADRs, especially drowsiness. Patients with eGFR < 32 mL/min/1.73 m 2 were likely to experience morphine-related ADRs.

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JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases

Cited by 25 publications

References 292 publications

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias

JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias

Adverse Drug Reactions in Japanese Patients with End-Stage Heart Failure Receiving Continuous Morphine Infusion: A Single-Center Retrospective Cohort Study

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