Optimizing outcomes: Impact of palliative care consultation timing in the cardiovascular intensive care unit

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2024-08-13 DOI:10.1016/j.hrtlng.2024.08.011

Sant Kumar MD , Hunter VanDolah BS , Ahmed Daniyaal Rasheed MD , Serenity Budd MS , Kelley Anderson PhD RN FNP , Alexander I. Papolos MD , Benjamin B.Kenigsberg M , Narayana Sarma V. Singam MD , Anirudh Rao MD , Hunter Groninger MD FAAHPM

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引用次数: 0

Abstract

Background

ICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied.

Objective

We explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency.

Methods

This retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (<72 h) and late (>72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models.

Results

The study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; p = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; p < 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, p < 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; p = 0.007), cardioversion (9.1% vs. 1.8 %; p = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; p = 0.007).

Conclusions

Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.

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优化疗效：心血管重症监护病房姑息关怀咨询时机的影响

背景由于疾病的严重性和预后的不确定性，重症监护病房（CICU）的患者及其家属承受着巨大的压力，因此姑息关怀（PC）对于症状管理、家庭支持和临终关怀目标而言是不可或缺的。我们探讨了早期姑息治疗咨询（PCC）对 CICU 患者预后的影响，包括死亡率、住院时间和家属会面频率。方法这项在 MedStar 华盛顿医院中心进行的回顾性研究纳入了 2021 年 12 月至 2022 年 6 月期间入住 CICU 并接受姑息治疗咨询的 209 名成人患者。我们比较了接受早期（72 小时）和晚期（72 小时）PCC 患者的治疗效果，包括死亡率、住院时间和家属会面频率。统计分析包括 Wilcoxon 秩和检验、Chi-squared 检验、费雪精确检验和泊松回归模型。结果该研究纳入了 209 名接受 PCC 的住院患者（中位年龄 = 68 岁，SD = 14；45 % 为女性；62 % 为黑人，30 % 为白人），其中大多数（79 %）在 72 小时内接受了 PCC。早期 PCC 患者与家人会面的几率更高（IRR=3.59；p <0.001），并且更早经历代码状态的改变（中位数为 1 天 vs. 3 天，p <0.001）。晚期 PCC 患者更有可能接受气管造口术（13.6% 对 2.4%；p = 0.007）、心脏电复律（9.1% 对 1.8%；p = 0.037）和放置 PEG 管（13.6% 对 2.4%；p = 0.007）。

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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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.