Palliative Care Consultation in Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Retrospective Cohort Study

2019 ◽  
Vol 22 (4) ◽  
pp. 432-436 ◽  
Author(s):  
Shunichi Nakagawa ◽  
Arthur R. Garan ◽  
Koji Takeda ◽  
Hiroo Takayama ◽  
Veli K. Topkara ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Cardiogenic Shock ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Short Term ◽  
Palliative Care Consultation ◽  
Care Consultation

Abstract 15170: In-hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jelani Grant ◽  
Louis Vincent ◽  
Bertrand Ebner ◽  
Jennifer Maning ◽  
Igor Vaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Experiences ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Palliative Care Consultation ◽  
Care Consultation

Introduction: Hospitalizations associated with advanced heart failure (HF) requiring mechanical circulatory support (MCS) are usually associated with a high morbidity, mortality and a protracted hospital course. Prior studies have shown that the early inclusion of palliative care specialist is associated with better end-of-life experiences. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes to identify patients above 18 years with advanced HF admitted with cardiogenic shock requiring MCS. Baseline characteristics and in-hospital outcomes were compared among patients evaluated by palliative care and those who were not. A p-value of <0.001 was considered statistically significant. Results: There were 748,360 patients hospitalized for advanced HF complicated by cardiogenic shock requiring MCS, of these a palliative care consult was placed in 118,015 (15.8%) patients. Patients evaluated by palliative care were older (70.6±14.9 vs. 64.9±16.3 years old, p<0.001) and had a higher prevalence of atrial fibrillation (39.3 vs. 35.1%,p<0.001) and chronic kidney disease (40.4 vs. 33.3, p<0.001), however had lower hypertension (57.4 vs. 59.7%, p<0.001), diabetes (35.4 vs. 36.5%, p<0.001), coronary artery disease (51.2 vs. 58.4%, p<0.001) and acute coronary syndromes (39.2 vs. 45.0%, p<0.001). Consulting palliative care was associated with a shorter length of stay (8.8±12.0 vs. 11.9±15.5 days, p<0.001), lower total hospital cost ($161,972±265,156 vs. $219,114±318,387, p<0.001) and higher Do Not Resuscitate (DNR) orders (30.8 vs. 5.8%, p<0.001). Mortality rates were higher in the palliative care cohort (73.4 vs. 29.4%, p<0.001). Conclusions: Despite the high morbidity and mortality associated with advanced HF patients with cardiogenic shock requiring MCS, the overall prevalence of palliative care consultation is exceedingly low. DNR orders were more prevalent in patients seen by the palliative care service. This study highlights the underutilization of palliative care services in this patient population, precluding any perceived benefit in end of life experiences.

scholarly journals Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Patcharaporn Prompantakorn ◽  
Chaisiri Angkurawaranon ◽  
Kanokporn Pinyopornpanish ◽  
Lalita Chutarattanakul ◽  
Chanchanok Aramrat ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Survival Time ◽  
Cancer Patients ◽  
Retrospective Cohort Study ◽  
Median Survival Time ◽  
Retrospective Cohort ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Performance Scale

Abstract Background Palliative Performance Scale (PPS) has been frequently used to estimate the survival time of palliative care patients. The objective was to determine the associations between the PPS and survival time among cancer and non-cancer patients in Thailand. Methods This is a retrospective cohort study. All in-patient adults who received a palliative care consultation at Chiang Mai University Hospital between 1 July 2018 to 31 July 2019 were included in the study and were followed-up until 26 June 2020. The Palliative Performance Scale was assessed using the validated Thai-Palliative Performance Scale for Adults. Survival analysis was used to determine the association between the Palliative Performance Scale and survival time among cancer and non-cancer patients. Results Out of 407 patients, 220 were male (54.1%). There were 307 cancer patients (75.4%) and 100 non-cancer patients (24.6%). The PPS and survival time in cancer patients were significantly correlated. Cancer patients with PPS 10, 20, 30, 40–60, and 70–80% had a median survival time of 2, 6, 13, 39, and 95 days, respectively. Non-cancer patients with PPS 10, 20, and 30% had a median survival time of 8, 6, and 24 days, respectively. Conclusions While useful for estimating survival time for cancer patients, other factors should be taken into account in estimating the survival time for non-cancer patients.

scholarly journals Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044196
Author(s):  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
Truong-Minh Pham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Chronic Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Specialist Palliative Care ◽  
Icu Admission

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

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