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

Author(s): Sivanathan, V; Smallwood, N; Strathmore, A; Johnson, D; Le, B; Zentner, D;
Details: Publication Year 2022-06,Volume 31,Issue #6,Page 841-848
Journal Title: Heart, Lung and Circulation
Publication Type: Research article
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.
Publisher: Elsevier
Keywords: Aged; Aged, 80 and over; Australia/epidemiology; Chronic Disease; *Heart Failure/epidemiology/therapy; Hospital Mortality; Humans; Male; Palliative Care/methods; Quality of Life; Retrospective Studies; *Terminal Care/methods; Dyspnoea; Heart failure; Palliative care; Terminal care
Department(s): Palliative Care
PubMed ID: 35153151
Publisher's Version: https://doi.org/10.1016/j.hlc.2022.01.002
Open Access at Publisher's Site: https://doi.org/10.1016/j.hlc.2022.01.002
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-04-04 05:25:09

Last Modified: 2025-04-04 05:39:07