Palliative care in heart failure

Abstract

Introduction: Heart failure is a prevalent clinical syndrome with high morbidity and mortality rates. Palliative care has an important role in symptomatic control. This study was designed to characterize the population referred to a palliative care unit and to identify those who benefit from early and regular intervention.

Aims: To characterize heart failure patients referred to a Palliative Care Team and identify those who would benefit from a regular intervention.

Methods: We performed a retrospective analysis of all the heart failure patients referred to our palliative care team between January 2015 and December 2017.

Results: A total of 54 patients were included with a mean age of 80 years. The mean score on the Palliative Performance Scale was 57. The median duration of disease was 46 months, 61.1% of patients were in NYHA class III, 57.4% had ejection fraction >40%, and 51.9% had ischemic cardiomyopathy. Most patients (94.4%) were referred during hospitalization; 60.8% were discharged, half with home-based assistance. Mortality one month after referral was 53.7%, and 83.3% after six months. We found no variables predictive of mortality within a month of referral.

Conclusions: This study contributes to the characterization of the heart failure population referred to palliative care. No clinical sign was predictive of one-month mortality, but the high mortality rate shows that patients are referred in advanced stages of the disease or frailty.

Keywords: Controlo sintomático; Heart failure; Insuficiência cardíaca; Medicina paliativa; Palliative care; Symptom management.