Frequency of Comfort Care and Palliative Care Consultation after ST-Elevation Myocardial Infarction

• Published in: Journal of pain and symptom management 2024-10, Vol.68 (4), p.402-409
• Main Authors: Abrams, Madeline, Carey, Matthew R., Nakagawa, Shunichi, Brener, Michael I., Fried, Justin A., Theodoropoulos, Kleanthis, Rabbani, Leroy, Uriel, Nir, Moses, Jeffrey W., Kirtane, Ajay J., Prasad, Megha
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiogenic shock; Female; Heart-Lung Machine - statistics & numerical data; Humans; Male; Mechanical circulatory support; Middle Aged; Palliative care; Palliative Care - statistics & numerical data; Patient Comfort - statistics & numerical data; Referral and Consultation - statistics & numerical data; Retrospective Studies; ST Elevation Myocardial Infarction - therapy; ST-elevation myocardial infarction
• ISSN: 0885-3924; 1873-6513; 1873-6513
• DOI: 10.1016/j.jpainsymman.2024.07.007

ST-elevation myocardial infarction (STEMI) remains a leading cause of death despite advances in revascularization and post-STEMI care. Especially for patients with a poor prognosis, there is increasing emphasis on comfort-focused care. We conducted a single-center retrospective cohort study of patients with STEMI at a large tertiary care academic medical center, abstracting patient-level data, causes of death, and use of palliative care consultation from the medical records. We sought to investigate the frequency of comfort-focused approaches and palliative care consultation after STEMI. A total of 536 patients presented with or were transferred with STEMI from January 2010 to July 2018, of whom 61/536 (11.4%) died during index hospitalization. Among those who underwent percutaneous intervention (PCI), the in-hospital mortality rate was 6.8%. Median (IQR) and time to death was two (0–6) days. Among those who died, 25/61 (41%) were treated with mechanical circulatory support (MCS). A total of 25/61 (41%) patients died following transition to a comfort-focused approach. Rate of MCS utilization during hospitalization was higher in the group that was ultimately transitioned to comfort-focused measures than the group who received full treatment measures. Palliative care was consulted in the case of 6/61 (9.8%) patients. Median time to consultation was 5 (1–7) days and time to death was 6.5 (2–28) days. Transition to comfort-focused care before death after STEMI is common, particularly in those with cardiogenic shock and/or treated with MCS, highlighting the critical status of such patients. Although increasingly employed in recent years, palliative care consults remain rare and are often employed late in the hospitalization.