Key result
Palliative care reaches only ~16% of ED heart failure patients, who face sharply higher mortality.
Why the study?
Heart failure is a common emergency department presentation that is underserved by palliative care services and associated with significant morbidity and mortality.
Observational (n=500)
Yes
Palliative care is underutilized and initiated late in heart failure patients presenting to the emergency department, suggesting the ED could be a key setting for early identification and referral.
ED heart failure visits show low palliative care use linked to higher mortality; leaves open whether earlier referral improves outcomes.
OBJECTIVES: Heart failure is a common ED presentation that is underserved by palliative care services and is associated with significant morbidity and mortality. We sought to evaluate use of palliative care services in patients with heart failure presenting to the ED. The primary outcome studied was palliative care involvement. Secondary outcomes of the study were: (1) 1-year mortality, (2) ED visits, (3) hospital admissions and (4) heart failure clinic involvement. METHODS: We conducted a health records review of 500 patients with heart failure who presented to two Canadian academic hospital EDs from January to August 2013. RESULTS: Patients were of mean age 80.7 years, women (53.2%) and had significant comorbidities. Only 41% of all deceased patients at 1 year had any palliative care involvement. Of those with palliative care, 44 (76%) patients had less than 2 weeks of palliative care involvement prior to death. Compared with those with no palliative care, the 79 (15.8%) patients with palliative care involvement had a higher 1-year mortality rate (70.9% vs 18.8%) and more hospital admissions/year (1.4 vs 0.85) for heart failure. CONCLUSIONS: We found that few patients with heart failure had palliative care services. Additionally, the majority of those who have palliative care involvement do not meet current recommendations for early palliative care involvement in heart failure. This study suggests that the ED may be an appropriate setting to identify and refer high-risk patients with heart failure who could benefit from earlier palliative care involvement.
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Lipinski et al. (2018) conducted an observational in heart failure (n=500). Palliative care involvement vs. No palliative care involvement was evaluated on palliative care involvement. Palliative care involvement was observed in only 15.8% of heart failure patients presenting to the ED, and these patients had a higher 1-year mortality rate (70.9% vs 18.8%) compared to those without.
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