Objective: The objective of this study was to provide data on implantable loop recorder (ILR)-based atrial fibrillation (AF) rates, recurrent stroke rates, and predictors of AF in patients with cryptogenic stroke (CS) after 1, 6, 12, 24, and 36 months of follow-up. Methods: We searched MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and reference lists of retrieved reports, which were published by April 30, 2023, which was the date of our last search. We utilized random-effects meta-analysis for detection rates, and meta-regression analysis, t-test (for normally distributed variables), and Mann-Whitney (for skewed variables) for predictor factors. Results: Thirteen studies were analyzed, which included data from 3,377 patients with CS or embolic stroke of undetermined source. The ILR-based AF rates in patients with CS were 4.73% (95% confidence interval [CI] 3.91–5.71) at 1 month, 13.45% (95% CI 12.19–14.81) at 6 months, 17.5% (95% CI 16.25–18.82) at 12 months, 20.69% (95% CI 19–22.49) at 24 months, and 25.98% (95% CI 23.21–28.58) at 36 months. Age and CHA2DS2-VASc score were positively associated with AF detection. Specifically, the mean difference of age and CHA2DS2-VASc score in the group with AF versus the group without AF was 7.47 (95% CI 4.58–10.36, P < 0.001) and 0.75 (95% CI 0.22–1.28, P = 0.01), respectively. Finally, AF detection was positively associated with recurrent strokes with an estimated risk ratio of 1.27 (95% CI 0.69–2.31). Conclusions: There is a correlation between AF detection rate and ILR monitoring duration. One out of eight patients was diagnosed with AF after 6 months of follow-up and about one quarter after 3 years. Our results demonstrate the critical use of ILRs, especially in older patients, and in patients with high CHA2DS2-VASc scores.
目的:本研究的目的是在随访1、6、12、24和36个月后，提供基于植入式环路记录仪(ILR)的隐源性卒中(CS)患者房颤(AF)发生率、卒中复发率和房颤预测因素的数据。方法:检索MEDLINE/PubMed、Cochrane Central Register of Controlled Trials、EMBASE、Web of Science和检索报告的参考文献列表，检索日期为2023年4月30日，即我们最后一次检索的日期。我们对检出率采用随机效应元分析，对预测因子采用元回归分析、t检验(正态分布变量)和Mann-Whitney检验(偏态变量)。结果:我们分析了13项研究，其中包括3377例来源不明的CS或栓塞性卒中患者的数据。CS患者基于ilr的AF发生率在1个月时为4.73%(95%可信区间[CI] 3.91-5.71)， 6个月时为13.45% (95% CI 12.19-14.81)， 12个月时为17.5% (95% CI 16.25-18.82)， 24个月时为20.69% (95% CI 19-22.49)， 36个月时为25.98% (95% CI 23.21-28.58)。年龄和CHA2DS2-VASc评分与房颤检测呈正相关。其中，房颤组与非房颤组年龄和CHA2DS2-VASc评分的平均差值分别为7.47 (95% CI 4.58 ~ 10.36, P < 0.001)和0.75 (95% CI 0.22 ~ 1.28, P = 0.01)。最后，房颤检测与卒中复发呈正相关，估计风险比为1.27 (95% CI 0.69-2.31)。结论:AF检出率与ILR监测时间存在相关性。1 / 8的患者在随访6个月后被诊断为房颤，约1 / 4的患者在随访3年后被诊断为房颤。我们的研究结果证明了ILRs的关键作用，特别是在老年患者和CHA2DS2-VASc评分高的患者中。
{"title":"The role of implantable loop recorder in patients with cryptogenic stroke: A systematic review and meta-analysis","authors":"KonstantinosA Gatzoulis, Kiriaki Mavromoustakou, Symeoni Katzouridi, Stergios Soulaidopoulos, Ioannis Doundoulakis, Achilleas Papadopoulos, Petros Arsenos, Skevos Sideris, Polychronis Dilaveris, Dimitris Tsiachris, Athanasios Kordalis, Konstantinos Tsioufis","doi":"10.4103/hm.hm-d-23-00030","DOIUrl":"https://doi.org/10.4103/hm.hm-d-23-00030","url":null,"abstract":"Objective: The objective of this study was to provide data on implantable loop recorder (ILR)-based atrial fibrillation (AF) rates, recurrent stroke rates, and predictors of AF in patients with cryptogenic stroke (CS) after 1, 6, 12, 24, and 36 months of follow-up. Methods: We searched MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and reference lists of retrieved reports, which were published by April 30, 2023, which was the date of our last search. We utilized random-effects meta-analysis for detection rates, and meta-regression analysis, t-test (for normally distributed variables), and Mann-Whitney (for skewed variables) for predictor factors. Results: Thirteen studies were analyzed, which included data from 3,377 patients with CS or embolic stroke of undetermined source. The ILR-based AF rates in patients with CS were 4.73% (95% confidence interval [CI] 3.91–5.71) at 1 month, 13.45% (95% CI 12.19–14.81) at 6 months, 17.5% (95% CI 16.25–18.82) at 12 months, 20.69% (95% CI 19–22.49) at 24 months, and 25.98% (95% CI 23.21–28.58) at 36 months. Age and CHA2DS2-VASc score were positively associated with AF detection. Specifically, the mean difference of age and CHA2DS2-VASc score in the group with AF versus the group without AF was 7.47 (95% CI 4.58–10.36, P < 0.001) and 0.75 (95% CI 0.22–1.28, P = 0.01), respectively. Finally, AF detection was positively associated with recurrent strokes with an estimated risk ratio of 1.27 (95% CI 0.69–2.31). Conclusions: There is a correlation between AF detection rate and ILR monitoring duration. One out of eight patients was diagnosed with AF after 6 months of follow-up and about one quarter after 3 years. Our results demonstrate the critical use of ILRs, especially in older patients, and in patients with high CHA2DS2-VASc scores.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiopulmonary exercise testing in heart failure risk assessment and prognosis","authors":"J. Laukkanen, S. Kunutsor","doi":"10.4103/hm.hm_57_22","DOIUrl":"https://doi.org/10.4103/hm.hm_57_22","url":null,"abstract":"","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"7 1","pages":"52 - 54"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47990755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cássia da Luz Goulart, R. Silva, M. Oliveira, G. Back, Ross Arena, M. Faghy, A. Borghi-Silva
The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that intervention in cardiopulmonary rehabilitation is of great importance, especially in the recovery stage, and should be carried out mainly with the aim of improving dyspnea, severe muscle weakness, and fatigue, to promote functional independence, and increase quality of life. Based on the limitations demonstrated in COVID-19 survivors, we developed a protocol based on the acronym #EASIER, which is divided into six phases. Such a study will be able to early identify the impact of COVID-19 in different severities as well as provide subsidies to guide physiotherapists early, through the correct prescription of rehabilitative interventional measures.
{"title":"Proposing an #EASIER cardiopulmonary rehabilitation protocol for coronavirus disease 2019 survivors","authors":"Cássia da Luz Goulart, R. Silva, M. Oliveira, G. Back, Ross Arena, M. Faghy, A. Borghi-Silva","doi":"10.4103/hm.hm_28_22","DOIUrl":"https://doi.org/10.4103/hm.hm_28_22","url":null,"abstract":"The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that intervention in cardiopulmonary rehabilitation is of great importance, especially in the recovery stage, and should be carried out mainly with the aim of improving dyspnea, severe muscle weakness, and fatigue, to promote functional independence, and increase quality of life. Based on the limitations demonstrated in COVID-19 survivors, we developed a protocol based on the acronym #EASIER, which is divided into six phases. Such a study will be able to early identify the impact of COVID-19 in different severities as well as provide subsidies to guide physiotherapists early, through the correct prescription of rehabilitative interventional measures.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"7 1","pages":"45 - 48"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44948455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The interaction between exercise and cardiovascular disease","authors":"Steven Bailey","doi":"10.4103/hm.hm_3_23","DOIUrl":"https://doi.org/10.4103/hm.hm_3_23","url":null,"abstract":"","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"7 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47701493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.
{"title":"Exercise and the brain in cardiovascular disease: A narrative review","authors":"Jenna L. Taylor","doi":"10.4103/hm.hm_50_22","DOIUrl":"https://doi.org/10.4103/hm.hm_50_22","url":null,"abstract":"Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"7 1","pages":"5 - 12"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41945089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the interview, Prof. Carl “Chip” J. Lavie gave suggestions on daily exercise, shared impressive cases of cardiovascular disease (CVD) patients, gave professional explanations of weight management and CVD outcomes, etc. His major viewpoints are: (a) psychological stress is a major risk factor for CVDs, (b) a low-level physical activity contributes to a high prevalence of most CVD risk factors, and regular exercise training can improve cardiac function and aerobic performance, and (c) the prognosis and survival among CVD patients with low physical activity are better in the obese than the lean.
{"title":"Improving fitness through exercise will improve our heart and mind","authors":"C. Lavie, Icey Zhang, Doris G. Yang, Meiyan Liu","doi":"10.4103/hm.hm_59_22","DOIUrl":"https://doi.org/10.4103/hm.hm_59_22","url":null,"abstract":"In the interview, Prof. Carl “Chip” J. Lavie gave suggestions on daily exercise, shared impressive cases of cardiovascular disease (CVD) patients, gave professional explanations of weight management and CVD outcomes, etc. His major viewpoints are: (a) psychological stress is a major risk factor for CVDs, (b) a low-level physical activity contributes to a high prevalence of most CVD risk factors, and regular exercise training can improve cardiac function and aerobic performance, and (c) the prognosis and survival among CVD patients with low physical activity are better in the obese than the lean.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"7 1","pages":"49 - 51"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46995471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/hm.hm-d-23-00016
Augusto Vicario, GustavoHernán Cerezo
The relationship between depression and cardiovascular disease (CVD) is bidirectional. Depression is a risk factor for developing CVD, and this, together with vascular risk factors (VascRFs), increases vulnerability to precipitate some types of geriatric depression (vascular depression). The particular semiology of depression of vascular origin (polymorphic), the symptoms of the comorbidities (vascular disease and/or risk factors), and those symptoms of old age constitute a challenge for clinical medicine. Although the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth/Fifth Edition do not differentiate between early-onset (young adult) and late-onset depression (older adult), the clinical expression of patients with depression of vascular origin presents its own characteristics as well as a poor response to treatment. Thus, cerebrovascular disease could be considered the link between VascRFs and the clinical expression of mood disorders (vascular depression), creating a challenge not only in its diagnosis but also in its treatment.
{"title":"The heart and brain connection: Contribution of cardiovascular disease to vascular depression – A narrative review","authors":"Augusto Vicario, GustavoHernán Cerezo","doi":"10.4103/hm.hm-d-23-00016","DOIUrl":"https://doi.org/10.4103/hm.hm-d-23-00016","url":null,"abstract":"The relationship between depression and cardiovascular disease (CVD) is bidirectional. Depression is a risk factor for developing CVD, and this, together with vascular risk factors (VascRFs), increases vulnerability to precipitate some types of geriatric depression (vascular depression). The particular semiology of depression of vascular origin (polymorphic), the symptoms of the comorbidities (vascular disease and/or risk factors), and those symptoms of old age constitute a challenge for clinical medicine. Although the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth/Fifth Edition do not differentiate between early-onset (young adult) and late-onset depression (older adult), the clinical expression of patients with depression of vascular origin presents its own characteristics as well as a poor response to treatment. Thus, cerebrovascular disease could be considered the link between VascRFs and the clinical expression of mood disorders (vascular depression), creating a challenge not only in its diagnosis but also in its treatment.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/hm.hm-d-23-00025
MollyM Jacobs, Elizabeth Evans, CharlesJr Ellis
Background: Notable disparities exist in ischemic heart disease (IHD) and stroke outcomes. Studies have identified several causal factors that contribute to these disparities, but few have assessed the disparate quality of life (QOL) among individuals living with IHD, stroke, or both. This study evaluated the impact of IHD, stroke, and both conditions on health-related QOL (HRQOL) and quantified existing disparities. Materials and Methods: Using the data from the 2021 National Health Interview Survey, we calculated the health and activities limitation index — a generic HRQOL measure comprising perceived health and activities limitations — for 29,482 adults. Adjusting for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status, the differences in HRQOL between racial and ethnic groups were estimated as well as racial/ethnic differences in the HRQOL of IHD, stroke, or both conditions. Results: Compared to those with neither condition, individuals with IHD (−0.214, Standard Error (SE)=0.015, stroke (−0.291, SE=0.028), and both (−0.438, SE=0.040) had 20% to 44% lower HRQOL. Blacks (−0.014, SE=0.004) and hispanics (−0.012, SE=0.003) had lower HRQOL compared to whites even after sample heterogeneity. Diagnosis with stroke (−0.182, SE=0.082), IHD (−0.137, SE=0.052), or both (−0.208, SE=0.126) lowered the HRQOL more for black individuals compared to white individuals, while other subgroups showed no statistically significant difference in HRQOL. In general, sex, age, and household composition showed little difference in adjusted HRQOL. Conclusion: While IHD and stroke are independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL, particularly among minoritized racial groups.
{"title":"Disparities in health-related quality of life among adults with ischemic heart disease, stroke, and both conditions: A cross-sectional study","authors":"MollyM Jacobs, Elizabeth Evans, CharlesJr Ellis","doi":"10.4103/hm.hm-d-23-00025","DOIUrl":"https://doi.org/10.4103/hm.hm-d-23-00025","url":null,"abstract":"Background: Notable disparities exist in ischemic heart disease (IHD) and stroke outcomes. Studies have identified several causal factors that contribute to these disparities, but few have assessed the disparate quality of life (QOL) among individuals living with IHD, stroke, or both. This study evaluated the impact of IHD, stroke, and both conditions on health-related QOL (HRQOL) and quantified existing disparities. Materials and Methods: Using the data from the 2021 National Health Interview Survey, we calculated the health and activities limitation index — a generic HRQOL measure comprising perceived health and activities limitations — for 29,482 adults. Adjusting for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status, the differences in HRQOL between racial and ethnic groups were estimated as well as racial/ethnic differences in the HRQOL of IHD, stroke, or both conditions. Results: Compared to those with neither condition, individuals with IHD (−0.214, Standard Error (SE)=0.015, stroke (−0.291, SE=0.028), and both (−0.438, SE=0.040) had 20% to 44% lower HRQOL. Blacks (−0.014, SE=0.004) and hispanics (−0.012, SE=0.003) had lower HRQOL compared to whites even after sample heterogeneity. Diagnosis with stroke (−0.182, SE=0.082), IHD (−0.137, SE=0.052), or both (−0.208, SE=0.126) lowered the HRQOL more for black individuals compared to white individuals, while other subgroups showed no statistically significant difference in HRQOL. In general, sex, age, and household composition showed little difference in adjusted HRQOL. Conclusion: While IHD and stroke are independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL, particularly among minoritized racial groups.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article explores the relationship of existential suffering and moral distress by examining life-threatening medical situations and the distress on persons engaged in medical ethics decision-making. The aim and focus are to articulate how existential suffering experienced by the patient and family generates moral distress in the health-care team as they perceive ongoing treatments as futile. Suffering and existential suffering pose a challenge ethically and therapeutically on a number of levels, first in terms of determining what a patient wants to be addressed or what a substitute decision-maker needs to consider in fulfilling the best interests of the patient who is suffering. Second, when there are unrelenting and intolerable sufferings, a difficult medical assessment is sometimes made that any further treatments are “futile,” which leads to conflict with the family and moral distress for the medical team. Moral distress and mental stress have physiological, psychological, social/behavioral, and existential-spiritual dimensions. Existential suffering consists of a constellation of factors, not only severe pain but also the inclusion of harms from the illness, which are irreversible, irremediable, and unrelenting, adding to the total suffering. This article argues that the existential suffering of the patient and family has a special moral status that significantly and legitimately guides decisions at the end of life, and addressing the existential suffering of the patient/family can relieve levels of moral distress for the health-care team.
{"title":"Existential suffering, futility, and the mental stress of moral distress in health care","authors":"Philip Crowell","doi":"10.4103/hm.hm_30_22","DOIUrl":"https://doi.org/10.4103/hm.hm_30_22","url":null,"abstract":"This article explores the relationship of existential suffering and moral distress by examining life-threatening medical situations and the distress on persons engaged in medical ethics decision-making. The aim and focus are to articulate how existential suffering experienced by the patient and family generates moral distress in the health-care team as they perceive ongoing treatments as futile. Suffering and existential suffering pose a challenge ethically and therapeutically on a number of levels, first in terms of determining what a patient wants to be addressed or what a substitute decision-maker needs to consider in fulfilling the best interests of the patient who is suffering. Second, when there are unrelenting and intolerable sufferings, a difficult medical assessment is sometimes made that any further treatments are “futile,” which leads to conflict with the family and moral distress for the medical team. Moral distress and mental stress have physiological, psychological, social/behavioral, and existential-spiritual dimensions. Existential suffering consists of a constellation of factors, not only severe pain but also the inclusion of harms from the illness, which are irreversible, irremediable, and unrelenting, adding to the total suffering. This article argues that the existential suffering of the patient and family has a special moral status that significantly and legitimately guides decisions at the end of life, and addressing the existential suffering of the patient/family can relieve levels of moral distress for the health-care team.","PeriodicalId":34653,"journal":{"name":"Heart and Mind","volume":"6 1","pages":"285 - 289"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49649769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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