Heart, Lung and Circulation

The Palliative Approach and Terminal Heart Failure Admissions – Are We Getting it Right?

Published:February 11, 2022DOI:


      Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life.


      To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure.


      Retrospective medical record review of all deaths from chronic heart failure (January 2010 to December 2019).


      Admissions with chronic heart failure resulting in death were analysed from an Australian tertiary referral centre.


      The cohort (n=517) were elderly (median age 83.8 years IQR=77.6–88.7) and male (55.1%). Common comorbidities were ischaemic heart disease (n=293 56.7%) and atrial fibrillation (n=289 55.9%). Life sustaining interventions occurred in 97 (18.8%) patients. In 31 (6.0%) patients referral to specialist palliative care occurred prior to, and in 263 (50.9%) during, the terminal admission. Opioids were prescribed to 440 (85.1%) patients. Comfort care was the documented goal in 158 patients (30.6%). A palliative approach was significantly associated with prior admission in the preceding 12 months (OR=1.5 95% CI=1.0–2.1 p<0.043), receiving outpatient care (OR=2.6 95% CI=1.6–4.1 p<0.01), and admissions in the latter half of the decade (OR=1.5 95% CI=1.0–2.0 p<0.038).


      Despite greater adoption of a palliative approach in the terminal admission over the last decade, a significant proportion of patients receive palliative care late, just prior to death.


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      Linked Article

      • Integrating Heart Failure Palliative Care Delivery in an Uncertain Disease Trajectory
        Heart, Lung and CirculationVol. 31Issue 6
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          Dying with end stage heart failure can be like a roller-coaster: a process punctuated by unpredictable episodes of acute deterioration, recovery, and often seemingly unexpected decline [1–3]. This not-so-predictable disease trajectory often results in referral to palliative care in only the terminal, or ‘end of life’ phase. Yet, late engagement with palliative care can result in increased hospitalisations, length of stays, depression [4], poor symptom management, and decreased quality of life, and most importantly, fewer days for patients and family members in their preferred place of care before they die [5–7].
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