The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right?
- Publisher:
- ELSEVIER SCIENCE INC
- Publication Type:
- Journal Article
- Citation:
- Heart Lung Circ, 2022, 31, (6), pp. 841-848
- Issue Date:
- 2022-06
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1-s2.0-S1443950622000294-main.pdf | 574.95 kB | Adobe PDF |
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Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author | Sivanathan, V | |
dc.contributor.author | Smallwood, N | |
dc.contributor.author | Strathmore, A | |
dc.contributor.author | Johnson, D | |
dc.contributor.author |
Le, B https://orcid.org/0000-0002-0830-4864 |
|
dc.contributor.author | Zentner, D | |
dc.date.accessioned | 2023-06-13T01:41:49Z | |
dc.date.available | 2022-01-02 | |
dc.date.available | 2023-06-13T01:41:49Z | |
dc.date.issued | 2022-06 | |
dc.identifier.citation | Heart Lung Circ, 2022, 31, (6), pp. 841-848 | |
dc.identifier.issn | 1443-9506 | |
dc.identifier.issn | 1444-2892 | |
dc.identifier.uri | http://hdl.handle.net/10453/170723 | |
dc.description.abstract | BACKGROUND: Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life. AIM: To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure. DESIGN: Retrospective medical record review of all deaths from chronic heart failure (January 2010 to December 2019). PARTICIPANTS: Admissions with chronic heart failure resulting in death were analysed from an Australian tertiary referral centre. RESULTS: The cohort (n=517) were elderly (median age 83.8 years IQR=77.6-88.7) and male (55.1%). Common comorbidities were ischaemic heart disease (n=293 56.7%) and atrial fibrillation (n=289 55.9%). Life sustaining interventions occurred in 97 (18.8%) patients. In 31 (6.0%) patients referral to specialist palliative care occurred prior to, and in 263 (50.9%) during, the terminal admission. Opioids were prescribed to 440 (85.1%) patients. Comfort care was the documented goal in 158 patients (30.6%). A palliative approach was significantly associated with prior admission in the preceding 12 months (OR=1.5 95% CI=1.0-2.1 p<0.043), receiving outpatient care (OR=2.6 95% CI=1.6-4.1 p<0.01), and admissions in the latter half of the decade (OR=1.5 95% CI=1.0-2.0 p<0.038). CONCLUSION: Despite greater adoption of a palliative approach in the terminal admission over the last decade, a significant proportion of patients receive palliative care late, just prior to death. | |
dc.format | Print-Electronic | |
dc.language | eng | |
dc.publisher | ELSEVIER SCIENCE INC | |
dc.relation.ispartof | Heart Lung Circ | |
dc.relation.isbasedon | 10.1016/j.hlc.2022.01.002 | |
dc.rights | info:eu-repo/semantics/closedAccess | |
dc.subject | 1102 Cardiorespiratory Medicine and Haematology, 1117 Public Health and Health Services | |
dc.subject.classification | Cardiovascular System & Hematology | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Chronic Disease | |
dc.subject.mesh | Heart Failure | |
dc.subject.mesh | Hospital Mortality | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Male | |
dc.subject.mesh | Palliative Care | |
dc.subject.mesh | Quality of Life | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Terminal Care | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Chronic Disease | |
dc.subject.mesh | Palliative Care | |
dc.subject.mesh | Terminal Care | |
dc.subject.mesh | Hospital Mortality | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Quality of Life | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Male | |
dc.subject.mesh | Heart Failure | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Chronic Disease | |
dc.subject.mesh | Heart Failure | |
dc.subject.mesh | Hospital Mortality | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Male | |
dc.subject.mesh | Palliative Care | |
dc.subject.mesh | Quality of Life | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Terminal Care | |
dc.title | The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right? | |
dc.type | Journal Article | |
utslib.citation.volume | 31 | |
utslib.location.activity | Australia | |
utslib.for | 1102 Cardiorespiratory Medicine and Haematology | |
utslib.for | 1117 Public Health and Health Services | |
pubs.organisational-group | /University of Technology Sydney | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health/IMPACCT | |
utslib.copyright.status | closed_access | * |
dc.date.updated | 2023-06-13T01:41:48Z | |
pubs.issue | 6 | |
pubs.publication-status | Published | |
pubs.volume | 31 | |
utslib.citation.issue | 6 |
Abstract:
BACKGROUND: Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life. AIM: To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure. DESIGN: Retrospective medical record review of all deaths from chronic heart failure (January 2010 to December 2019). PARTICIPANTS: Admissions with chronic heart failure resulting in death were analysed from an Australian tertiary referral centre. RESULTS: The cohort (n=517) were elderly (median age 83.8 years IQR=77.6-88.7) and male (55.1%). Common comorbidities were ischaemic heart disease (n=293 56.7%) and atrial fibrillation (n=289 55.9%). Life sustaining interventions occurred in 97 (18.8%) patients. In 31 (6.0%) patients referral to specialist palliative care occurred prior to, and in 263 (50.9%) during, the terminal admission. Opioids were prescribed to 440 (85.1%) patients. Comfort care was the documented goal in 158 patients (30.6%). A palliative approach was significantly associated with prior admission in the preceding 12 months (OR=1.5 95% CI=1.0-2.1 p<0.043), receiving outpatient care (OR=2.6 95% CI=1.6-4.1 p<0.01), and admissions in the latter half of the decade (OR=1.5 95% CI=1.0-2.0 p<0.038). CONCLUSION: Despite greater adoption of a palliative approach in the terminal admission over the last decade, a significant proportion of patients receive palliative care late, just prior to death.
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