Palliative care consultations for heart failure patients: How many, when, and why?

Academic Article

Abstract

  • Objective: In preparation for development of a palliative care intervention for patients with heart failure (HF) and their caregivers, we aimed to characterize the HF population receiving palliative care consultations (PCCs). Methods and Results: Reviewing charts from January 2006 to April 2011, we analyzed HF patient data including demographic and clinical characteristics, Seattle Heart Failure scores, and PCCs. Using Atlas qualitative software, we conducted a content analysis of PCC notes to characterize palliative care assessment and treatment recommendations. There were 132 HF patients with PCCs, of which 37% were New York Heart Association functional class III and 50% functional class IV. Retrospectively computed Seattle Heart Failure scores predicted 1-year mortality of 29% [interquartile range (IQR) 19-45] and median life expectancy of 2.8 years [IQR 1.6-4.2] years. Of the 132 HF patients, 115 (87%) had died by the time of the audit. In that cohort the actual median time from PCC to death was 21 [IQR 3-125] days. Reasons documented for PCCs included goals of care (80%), decision making (24%), hospice referral/discussion (24%), and symptom management (8%). Conclusions: Despite recommendations, PCCs are not being initiated until the last month of life. Earlier referral for PCC may allow for integration of a broader array of palliative care services. © 2013 Elsevier Inc. All rights reserved.
  • Published In

    Digital Object Identifier (doi)

    Author List

  • Bakitas M; Macmartin M; Trzepkowski K; Robert A; Jackson L; Brown JR; Dionne-Odom JN; Kono A
  • Start Page

  • 193
  • End Page

  • 201
  • Volume

  • 19
  • Issue

  • 3