Palabras clave
Insuficiencia cardíaca
Calidad de vida
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Resumen
Objetivo: Analizar el momento adecuado para integrar los cuidados paliativos en pacientes con insuficiencia cardíaca avanzada y discutir estrategias para un abordaje humanizado y centrado en la persona. Revisión bibliográfica: La trayectoria imprevisible de la insuficiencia cardíaca dificulta delimitar la terminalidad y favorece derivaciones tardías. La literatura indica que las necesidades paliativas deben evaluarse según la carga sintomática persistente, hospitalizaciones recurrentes, deterioro funcional, fragilidad, sufrimiento psicosocial, sobrecarga del cuidador y complejidad de las decisiones terapéuticas. Los ensayos clínicos y las síntesis de evidencia muestran resultados heterogéneos, con beneficios más consistentes sobre síntomas, calidad de vida, comunicación, apoyo familiar y utilización de servicios que sobre mortalidad. Los modelos ambulatorios, domiciliarios y de telesalud pueden ampliar el acceso cuando se integran al tratamiento cardiológico y se adaptan a las necesidades individuales. Consideraciones finales: Los cuidados paliativos deben incorporarse progresivamente al manejo de la insuficiencia cardíaca avanzada, sin depender exclusivamente de la proximidad de la muerte. El abordaje debe combinar control activo de síntomas, comunicación clara, toma de decisiones compartida, apoyo a los cuidadores y atención a las desigualdades de acceso.
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