Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

Abstract

Aims Estimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care. Methods and results This retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days. Conclusions The PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.

The Development and Implementation of a Cardiac Home Hospice Program: Results of a RE-AIM Analysis

“…The most common Palliative Performance Scores on hospice admission ranged between 10% and 30% for about 40% of the patient sample, indicating severe impairment and disease progression. 27,28…”

“…The most common Palliative Performance Scores on hospice admission ranged between 10% and 30% for about 40% of the patient sample, indicating severe impairment and disease progression. 27,28 The primary reason for hospice discharge was death (71%), and most patients were female (57%), non-Hispanic white (51%), and referred directly from the hospital (55%). Although the majority of the sample was non-Hispanic white, almost half of our sample was comprised of patients of other races and ethnicities (49%).…”

The Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19

“…Anderson et al, 12 developed the Palliative Performance Scale to help assess prognosis in cancer patients receiving palliative care and it has since been applied to other seriously ill populations. 9 , 13 – 15 The score is calculated from five domains: ambulation, activity and evidence of disease, self-care, intake and level of consciousness. Scores range from 0 to 100.…”

The Turkish Validity and Reliability Study of Palliative Performance Scale

“…Although initially designed for palliative adults with advanced illness, the PPSv2 has been utilized across various settings for others based on performance or functional status. [ 13 ] Since its development, it has been translated and validated in different languages. [ 14 15 16 ] PPSv2 is being increasingly used in studies or palliative care units in the country, but the Turkish reliability and validity study is not still performed.…”