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

• Published in: Heart & lung 2024-11, Vol.68, p.265-271
• Main Authors: Kumar, Sant, VanDolah, Hunter, Rasheed, Ahmed Daniyaal, Budd, Serenity, Anderson, Kelley, Papolos, Alexander I., M, Benjamin B.Kenigsberg, Singam, Narayana Sarma V., Rao, Anirudh, Groninger, Hunter
• Format: Article
• Language: English
• Subjects: Aged; Cardiac intensive care unit; Cardiovascular Diseases - therapy; CICU; Coronary Care Units - statistics & numerical data; Family meetings; Female; Hospital Mortality - trends; Humans; ICU; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Middle Aged; Palliative care; Palliative Care - methods; Palliative Care - statistics & numerical data; Referral and Consultation - statistics & numerical data; Retrospective Studies; Time Factors
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2024.08.011

•Among CICU patients, patients with early palliative care consultation (PCC) had more family meetings and more rapid changes in code status.•Patients with late PCC were more likely to undergo invasive procedures like tracheostomy, cardioversion, and percutaneous gastrostomy (PEG) tube placement.•The median length of stay was shorter for early PCC patients than late PCC patients.•Mortality rates were similar between early and late PCC groups. 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. 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. 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) 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. 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). Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.