Improving End-of-Life Care for Patients in Australian Cardiology Wards: A Retrospective Medical Record Audit

Dynamic hospital settings such as cardiology wards face challenges in delivering high-quality end-of-life care due to high patient volumes, urgent clinical demands, variable disease trajectories, and time pressures, often resulting in delayed goals-of-care discussions and suboptimal care. Despite the availability of national End-of-Life Care Standards and associated quality audit tools, evidence describing their use and end-of-life care practices in Australian cardiology wards remains limited. We aimed to examine end-of-life care in cardiology wards within Australian hospitals.

A retrospective medical record audit was conducted using the Australian Commission on Safety and Quality in Health Care's End-of-Life Audit Tool. The audit included 150 consecutive adult patients who died on cardiology wards across three Australian hospitals between February 2023 and February 2025.

The median age of patients at death was 81 years, with 8.7% (n=13) having a documented Advance Care Directive during the admission. Following admission to cardiology wards, 64.7% of patients were recognised as dying, with the average time between recognition of dying to death being 28 hours. The majority (n=134) of patients had a documented resuscitation plan and 70% were referred to palliative care during their final hospital admission. In their final 48 hours of life, 76% (n=114) of patients received active investigations and/or interventions, whilst 41.7% of those identified as dying more than 48 hours before death also continued to receive active interventions and/or investigations in the last 2 days of life.

This study highlights that whilst some elements of high-quality end-of-life care are being provided in cardiology wards, earlier recognition of dying, improved adherence to evidence-based care and more proactive communication are needed to achieve alignment with the national standards.