Palliative consultations occur late among heart failure patients
By Sarah Guy, medwireNews Reporter
19 March 2013
J Card Fail 2013; 19: 193–201

medwireNews: Patients treated for heart failure (HF) only receive palliative care consultations (PCC) in the late stage of their illness, suggesting a reactive rather than proactive approach to care, say US researchers.

"In addition to decreasing the symptom burden, initiating advanced care planning can be valuable for patients with an unpredictable illness trajectory that is subject to unanticipated episodes of acute and life-threatening decompensation," writes the team in the Journal of Cardiac Failure.

Indeed, earlier PCC can mitigate symptoms as well as benefit the family in terms of preparation and support, add Marie Bakitas (Geisel School of Medicine at Dartmouth, Hanover, New Hampshire) and colleagues.

The researchers reviewed the charts of 1320 HF patients treated between January 2006 and April 2011 to characterize palliative care assessment and treatment recommendations.

Patients were aged a mean of 74 years, just over half were male (53%), and 132 (10%) received a PCC either as an inpatient (n=115) or an outpatient (n=17) at the researchers' institution.

The Seattle Heart Failure Model predicted a median 1-year survival rate of 72% for those who received a PCC; however, the actual median survival time from PCC to death was 21 days, which was "remarkably short," according to Bakitas et al.

"This suggests that this cohort was identified by their clinician for PCC when they were acutely and seriously medically ill and in their later stages of dying," notes the team.

The primary reason a PCC was initiated according to patients' notes was to outline goals of care (80%), with decision-making support and hospice referral or discussion the next most likely reasons for PCC (24% each).

The need to establish goals of care "typically signals that a structured discussion is needed about the ineffectiveness of tried medical treatments and the need to adopt a philosophy of care based on patients values and preferences," suggest the authors.

They explain that the challenge in HF is to identify those who might benefit from the "full range" of palliative services earlier in the disease course, including advanced care planning, effective communication strategies, and treatment decision making.

Furthermore, while the majority of palliative care interventions have been developed with a cancer population in mind, there are many lessons to be learned that can be applied to the HF population, conclude Bakitas and co-workers.

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