Referrals to Palliative Care for Cardiovascular Patients: A 10-Year Longitudinal Retrospective Study

L. Van Bulck, Mathilde Giffard, Fatimata Seydou Sall, N. Becoulet, M. Séronde, F. Ecarnot
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Abstract

Patients with cardiovascular diseases have a significant symptom burden and often have a progressive course towards end-stage disease and ultimately, death. For this reason, consensus guidelines advocate early integration of palliative care into the care for cardiovascular patients, especially those with heart failure. However, palliative care involvement in the care of cardiovascular patients remains suboptimal, whereby only a small proportion of patients are referred to palliative care specialists, and often too late in the disease course. We aimed to examine the current situation and describe the profile, circumstances of death, and time of referral to palliative care of cardiovascular patients over a 10 year period in our unit. This retrospective study included all patients with cardiovascular disease who were referred to the mobile palliative care team by the cardiology unit, in a single, large University Hospital in France between 2010 and 2020. All data were extracted from the medical hospital files. We recorded vital status, day of birth, time of referral to palliative care, day of death, and medical diagnoses. We noted whether patients had advance directives (AD). A total of 148 patients were identified; full data were available for 144 (97.3%). Of these, 136 (94.4%) died, while 8 (5.6%) were still alive in March 2022. The mean age at the time of death was 75±14 years. The median time between referral to palliative care and death was 9 days (interquartiles, 2, 41.5). We noted the following underlying diseases (patients could have more than one diagnosis): 111 (77%) had heart failure, 58 (40.2%) had ischemic heart disease, 55 (38.2%) had valvular heart disease, 39 (27%) had diabetes, 37 (25.7%) had chronic kidney disease, 30 (20.8%) had pulmonary hypertension, 17 (11.8%) had chronic obstructive pulmonary disease. In addition, 78 (54%) had at least one documented episode of atrial fibrillation, 27 (18.7%) had had a stroke. Place of death was available for 119 patients (82.6%) (Figure): The majority (73, 61.4%) died in the Cardiology department of our hospital; only 17 (14.3%) died at home (see Figure 1). Only 4 patients (2.7%) had documented AD. This study suggests that palliative care is still widely under-used in cardiology patients, and is often initiated very close to the time of death, and mainly for heart failure patients. A large proportion of patients still die in the hospital setting. Further, prospective studies are warranted to investigate whether these dispositions corresponds to patients' wishes, and whether earlier initiation of palliative care could improve quality of life for cardiology patients with end-stage disease. Type of funding sources: None.
转诊到姑息治疗的心血管病人:一项10年的纵向回顾性研究
心血管疾病患者具有显著的症状负担,并且往往具有向终末期疾病发展并最终死亡的进展过程。因此,共识指南提倡将姑息治疗早期纳入心血管患者的护理中,特别是心力衰竭患者。然而,姑息治疗参与心血管患者的护理仍然不够理想,因此只有一小部分患者被转诊给姑息治疗专家,而且往往在病程中太晚。我们的目的是检查目前的情况和描述的概况,死亡的情况,以及转诊到姑息治疗的心血管病人的时间超过10年期间在我们的单位。这项回顾性研究包括2010年至2020年间法国一家大型大学医院心脏病科转介到流动姑息治疗小组的所有心血管疾病患者。所有数据均取自医院档案。我们记录了生命体征、出生日期、转介到姑息治疗的时间、死亡日期和医疗诊断。我们注意到患者是否有预先指示(AD)。共确定了148例患者;144例(97.3%)有完整资料。到2022年3月,其中136人(94.4%)死亡,8人(5.6%)仍然活着。死亡时平均年龄为75±14岁。转诊到姑息治疗和死亡之间的中位时间为9天(四分位数间为2,41.5)。我们注意到以下基础疾病(患者可能有不止一种诊断):111例(77%)患有心力衰竭,58例(40.2%)患有缺血性心脏病,55例(38.2%)患有瓣膜性心脏病,39例(27%)患有糖尿病,37例(25.7%)患有慢性肾病,30例(20.8%)患有肺动脉高压,17例(11.8%)患有慢性阻塞性肺疾病。此外,78人(54%)至少有一次房颤发作,27人(18.7%)有过中风。死亡地点可查119例(占82.6%)(图):主要死亡地点为我院心内科(73例,占61.4%);只有17例(14.3%)在家中死亡(见图1)。只有4例(2.7%)记录为AD。这项研究表明,姑息治疗在心脏病患者中仍然广泛使用不足,并且通常在非常接近死亡时间时开始,主要用于心力衰竭患者。很大一部分患者仍然死在医院环境中。此外,有必要进行前瞻性研究,以调查这些倾向是否符合患者的意愿,以及早期开始姑息治疗是否可以改善终末期心脏病患者的生活质量。资金来源类型:无。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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