Palliative-Oriented Referral and Advanced Vulnerability in Very Old Patients Hospitalised for Acute Heart Failure

BACKGROUND: Palliative-oriented referral in very old patients hospitalised for acute heart failure (HF) is common in cardiogeriatric practice, but their clinical profile and outcomes remain poorly described. We used referral to the French Identified Palliative Care Bed model, Lits Identifiés de Soins Palliatifs (LISP), as a real-world marker. METHODS: This retrospective single-centre study included patients aged >65 years discharged after acute HF hospitalisation from a cardiogeriatric unit between 1 January and 24 September 2025. Patients who died during the index stay, objected to secondary data use, or had missing/non-interpretable 3-month follow-up were excluded. RESULTS: Among 604 patients analysed (mean age 86.9 ± 7.1 years; 52% women), 106 had LISP referral. In exploratory multivariable logistic regression, LISP referral was associated with lower Activities of Daily Living score [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.37-0.55; P < 0.001], major neurocognitive disorders (OR 2.98, 95% CI 1.73-5.13; P < 0.001), higher log-transformed discharge NT-proBNP (OR 1.35, 95% CI 1.08-1.69; P = 0.008), lower SGLT2 inhibitor use among patients with LVEF >50% (OR 0.49, 95% CI 0.27-0.88; P = 0.017), and fewer discharge medications (OR 0.88, 95% CI 0.79-0.97; P = 0.011). LISP referral was associated with higher mortality and lower 6-month survival (47.6% vs. 79.5%). CONCLUSION: LISP referral identified very old patients with acute HF, advanced multidimensional vulnerability, higher NT-proBNP levels, and high short-term mortality. It should be interpreted as a clinician-assigned marker, not as a causal determinant of prognosis.