The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right?

Sivanathan, V; Smallwood, N; Strathmore, A; Johnson, D; Le, B; Zentner, D

The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right?

Sivanathan, V Smallwood, N Strathmore, A Johnson, D Le, B

Zentner, D

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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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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.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/170723