Abstract 16384: Eight Years of Experience in Palliative Care Consultation in a University Hospital for Inpatients With Advanced Heart Disease. What Have We Learned So Far and Which Are the Perspectives for the Future?

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A16384-A16384
• Main Authors: Dei Santi, Daniel, Canosa, Henrique, Rocha, Juraci, Crispim, Douglas, Carvalho, Ricardo T
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionPatients with advanced heart failure have high mortality, suffering and symptoms difficult to control, and great need of health resources, benefiting from palliative care (PC).MethodsReview of standardized forms and medical records of 433 inpatients with advanced heart disease from March 2010 to December 2017 in a university hospital of cardiology, for whom PC consultations were requested.ResultsA continuous increase in the number of requests was observed after the start of the PC consultation program, from 20 requests in 2010 to 125 in 2017 (an increase of 525%). Patients were 57.7% men, median age of 73 years (IQR 61-82), 23% had ischemic heart disease, median ejection fraction of 34% (IQR 25-45). Bedridden patients with high dependence represented 76% of the cases. Patients in actively dying process at first evaluation decreased from 70% to 43% (p=0.025) between 2010 and 2017. The emergency room was initially responsible for only 15% of the requests, reaching 51% in 2017 (p=0.002) reflecting greater recognition of the need for PC already in the first days after admission. The number of days required after admission for requests to be made were also reduced from a median of 33 (IQR 11-65) to 5 (IQR 1-20) days. There was a decrease in the frequency of in hospital deaths (from 75% to 47%, p=0.020); on the other hand, the discharges for outpatient PC follow up increased from 10 to 24% (p=0.16). Until 2013 more than 80% of ICU patients died at ICU beds, but after 2014 around 50% were relocated into PC facilities. Of all patients, 34% had indication for allocation in PC ward and 11% in hospice for end of life care; however, they were accomplished only in 19% and 4% of the cases, respectively. Despite an increase of the need for transfers over the 8 years, we observed that in the last 3 years there was a stagnation in the transfer capacity, possibly limited by the low availability of PC beds.Conclusiondespite of the greater recognition by cardiologists regarding the need for PC, it is still below the real need and often been made late in the course of the disease. With earlier recognition of terminal stage, propagation of PC knowledge, research and greater availability of PC beds and health resources, it is possible to increase the PC assistance network and make it more effective.