When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative...

Area of Science:

• Palliative Care
• Geriatric Medicine
• Cardiology

Background:

• A 67-year-old male with multiple comorbidities including coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was deemed high-risk for coronary artery bypass graft (CABG) surgery.
• The patient experienced a recent myocardial infarction, necessitating urgent surgical consideration despite the elevated perioperative risks.

Observation:

• During the waiting period for surgery, the patient developed acute renal failure and required intensive care unit (ICU) admission.
• Following consultation, the patient and his wife were informed that CABG surgery was no longer a viable option due to the patient's deteriorating condition.

Findings:

• The patient opted to decline further intensive care, choosing comfort-focused palliative measures.
• The patient died peacefully, indicating a potentially successful transition to palliative care.

Implications:

• This case suggests that structured palliative care models, often used in oncology, can be adapted and are feasible for non-oncologic patients with critical illnesses.
• Implementing palliative care early in non-oncologic critical illness may improve patient outcomes and align with patient-centered goals of care.