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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
Published on: July 12, 2024
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Palliative care integration into outpatient heart failure management: pilot study
Shamara Nadarajah1, Giovanna Sirianni1,2,3, Stephanie Poon1,4,5
1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Supportive & Palliative Care
|October 29, 2024
Summary
Integrating palliative medicine into heart failure clinics increased advance care planning significantly. This model supports patients early, when they are more functional and have fewer symptoms.
Area of Science:
- Cardiology
- Palliative Medicine
- Health Services Research
Background:
- Heart failure patients have unmet palliative care needs, leading to underutilization of services.
- Heart failure clinics represent a potential setting for early palliative care delivery, but evidence is limited.
- An embedded model of palliative medicine within a heart failure clinic was investigated.
Purpose of the Study:
- To explore the outcomes of integrating palliative medicine services within a heart failure clinic.
- To assess the impact of this embedded model on patient care and advance care planning.
Main Methods:
- Retrospective cohort study of patients receiving palliative medicine consultation in a heart failure clinic.
- Descriptive statistics to characterize the cohort and outcomes.
- McNemar test to compare advance care planning rates before and after consultation.
Main Results:
- Most patients had New York Heart Association (NYHA) class II symptoms and a Palliative Performance Scale score of ≥60%.
- Advance care planning increased from 17% pre-consultation to 93% during the first consultation (p<0.001).
- Care encompassed advance care planning (95%), symptom management (97%), and caregiver support (30%).
Conclusions:
- An embedded palliative medicine model in heart failure clinics increases advance care planning.
- This intervention is effective when patients are functional and minimally symptomatic.
- Further research is needed to validate these findings across multiple sites.
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