The right time for palliative care in heart failure: a review of critical moments for palliative care intervention

Slavin, Samuel D.; Warraich, Haider J.

doi:10.1016/j.rec.2019.07.013

Cited by 12 publications

(13 citation statements)

References 37 publications

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“…Despite professional guideline recommendations for palliative care involvement for heart failure patients [ 37 ], there is no clear consensus regarding when and how to implement palliative care services. Slavin and Warraich suggest initiating specialty palliative care referral at critical moments in the trajectory of heart failure patients, such as at the time of hospitalization or evaluation for certain procedures [ 38 ]. Our work affirms the inadequacy of mortality-based triggers for identifying SPC needs among the population of patients with cardiovascular critical illness.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study

et al. 2021

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Introduction Automated specialty palliative care consultation (SPC) has been proposed as an intervention to improve patient-centered care in the intensive care unit (ICU). Existing automated SPC trigger criteria are designed to identify patients at highest risk of in-hospital death. We sought to evaluate common mortality-based SPC triggers and determine whether these triggers reflect actual use of SPC consultation. We additionally aimed to characterize the population of patients who receive SPC without meeting mortality-based triggers. Methods We conducted a retrospective cohort study of all adult ICU admissions from 2012–2017 at an academic medical center with five subspecialty ICUs to determine the sensitivity and specificity of the five most common SPC triggers for predicting receipt of SPC. Among ICU admissions receiving SPC, we assessed differences in patients who met any SPC trigger compared to those who met none. Results Of 48,744 eligible admissions, 1,965 (4.03%) received SPC; 979 (49.82%) of consultations met at least 1 trigger. The sensitivity and specificity for any trigger predicting SPC was 49.82% and 79.61%, respectively. Patients who met no triggers but received SPC were younger (62.71 years vs 66.58 years, mean difference (MD) 3.87 years (95% confidence interval (CI) 2.44–5.30) p<0.001), had longer ICU length of stay (11.43 days vs 8.42 days, MD -3.01 days (95% CI -4.30 –-1.72) p<0.001), and had a lower rate of in-hospital death (48.68% vs 58.12%, p<0.001). Conclusion Mortality-based triggers for specialty palliative care poorly reflect actual use of SPC in the ICU. Reliance on such triggers may unintentionally overlook an important population of patients with clinician-identified palliative care needs.

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Section: Discussionmentioning

confidence: 99%

Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study

et al. 2021

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“…As such, hospitalisations become an important 'touch point' during which to elicit patient goals and values around their care and engage PC. 15 At the provider level, raising awareness of guidelines and the role of PC in alleviating suffering is an important first step among hospitalists and cardiologists alike. 2 Additionally, interventions specifically aiming to enhance interprofessional and interprovider communication could help clarify roles and expectations around when and how to introduce PC to patients who traverse many care settings and providers.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing palliative care referral for hospitalised patients with heart failure: an exploratory, randomised, multi-institutional survey of hospitalists and cardiologists

et al. 2020

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ObjectiveTo identify factors influencing cardiologists’ and hospitalists’ decisions regarding palliative care referral among hospitalised patients with advanced heart failure.DesignAn exploratory, randomised vignette-based survey.SettingCardiology and hospitalist divisions at three Michigan State institutions and the Society of Hospital Medicine’s Michigan Chapter.Participants145 hospitalists and 64 cardiologists.Outcome measuresPrimary outcomes included participants’ reports of their likelihood of referring a standardised patient with an acute heart failure exacerbation with multiple prior hospital admissions and acute renal failure to palliative care (scale of 0%–100%) after the initial stem and after being cued with three randomised vignette modifiers, including the presence versus the absence of continuity with an outpatient cardiologist; the presence versus the absence of documented advance care planning; and the patient voicing that he is accepting of his severe illness versus wanting everything done. Adjusted generalised linear models and predictive margins were used to evaluate the impact of each randomised modifier on referral decisions. An interaction term evaluated the effect of provider specialty on outcomes. Secondary outcomes included participants’ reports of their general practices around palliative care delivery to hospitalised patients with heart failure.ResultsResponse rate was 31.3%. Predictive margins from generalised linear models demonstrated a statistically significantly higher likelihood of referral to inpatient palliative care if the patient lacked an outpatient cardiologist (mean difference: 6.3% (95% CI 1.8% to 10.8%)); had prior advance care planning documentation (mean difference: 9.7% (95% CI 4.4% to 15.0%)); and was accepting of illness severity (mean difference: 29.6% (95% CI 24.8% to 34.4%)). No interaction effect was noted based on provider specialty. Most hospitalists and cardiologists were unaware of palliative care guidelines for patients with heart failure (74.3% vs 70.3%, p=0.71).ConclusionsA number of patient and provider factors influence palliative care referral decisions in hospitalised patients with advanced heart failure.

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“…18 Nurses can provide "primary palliative care" while physicians and advanced practitioners with specialized training in palliative care provide "secondary palliative care." 1 Primary palliative care is incorporated into many aspects of nursing care that is provided by critical care nurses, including symptom management, medication management, goals of care, and promoting QOL. 8 When HF progresses to a more complex level, specialized services (if available) can be added by consulting with clinicians with training to provide supportive care that includes physiological, psychosocial, functional, social, ethical/legal, and financial concerns as well as complex symptom management, complicated advance care planning, or difficult decision-making.…”

Section: Integrating Palliative Models Of Care Across the Hf Continuummentioning

confidence: 99%

“…However, extrapolating from existing data, palliative care intervention is likely to be beneficial for patients with HF who are admitted to the ICU because these patients have a similar high risk of mortality. 1 Critical care nurses have the opportunity to discuss palliative care with patients with HF in the inpatient setting and coordinate transitions of care with providers in the outpatient setting during discharge planning.…”

Section: Family Caregiver Participationmentioning

confidence: 99%

“…Hospitalization and treatment in the intensive care unit (ICU) for acute HF are critical events in the disease trajectory of HF when palliative care should be considered. 1 Palliative care for HF patients is an emerging field with limited studies that specifically address this population. The purpose of this article is to provide an overview of palliative care in the ICU or progressive care unit for patients with HF.…”

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confidence: 99%

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Integrating Palliative Care Into Heart Failure Management

Bierle

Vuckovic

Ryan

2021

Critical Care Nurse

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Background The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. Clinical Relevance The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient’s quality of life. Purpose To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. Content Covered This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.

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The right time for palliative care in heart failure: a review of critical moments for palliative care intervention

Cited by 12 publications

References 37 publications

Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study

Evaluation of automated specialty palliative care in the intensive care unit: A retrospective cohort study

Factors influencing palliative care referral for hospitalised patients with heart failure: an exploratory, randomised, multi-institutional survey of hospitalists and cardiologists

Integrating Palliative Care Into Heart Failure Management

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