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Identifying patients with supportive and palliative care needs in acute cardiology
  1. S J Fenning1,
  2. R Woolcock1,
  3. K Haga1,
  4. C Skene2,
  5. K Boyd3,
  6. S A Murray3 and
  7. M Denvir2
  1. 1College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK

Abstract

Introduction and aims Due to the variable illness trajectory and uncertain prognosis, most patients with advanced heart disease fail to receive adequate end-of-life care. The Gold Standards Framework (GSF) has been used in primary care to identify such patients. We assessed its utility in patients presenting in the acute hospital setting with acute coronary syndrome (ACS).

Methods Consecutive patients with ACS admitted to an acute cardiology unit, over two separate 4 week periods, were included. Data were collected from patient notes and interviews with doctors. Patients were assessed using GSF and a clinical prognostic score (Global Registry of Acute Coronary Events, GRACE). All patients were followed-up for 1 year.

Results 168 patients were included. 40 (24%) patients were identified under the GSF as being in the last year of life due to their heart disease. Compared with GSF negative patients, GSF positive patients had a significantly higher GRACE score (13.9 vs 8.3, p=0.002). The GRACE score of patients who died within 6 months was significantly higher than those who survived (20.2 vs 9.27, p=0.008). GSF poorly predicted 6 month mortality (sensitivity 17%) but was strongly predictive of all-cause readmission during follow-up (p=0.000001).

Conclusion GSF may be useful in predicting readmissions in ACS patients but is poor at predicting mortality. Combining GSF criteria with GRACE may guide secondary care clinicians in identifying ACS patients who may benefit from end of life care.

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