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PHASE 2 RANDOMISED CONTROLLED TRIAL OF FUTURE CARE PLANNING IN PATIENTS WITH ADVANCED HEART DISEASE
  1. M A Denvir1,
  2. G Highet2,
  3. K Boyd2,
  4. S Robertson1,
  5. S Cudmore1,
  6. L Donald1,
  7. K Haga3,
  8. C Weir4 and
  9. S Murray5
  1. 1Edinburgh Heart Centre, Royal Infirmary of Edinburgh
  2. 2Department of Palliative Care, Royal Infirmary of Edinburgh
  3. 3University of Edinburgh, School of Clinical Sciences
  4. 4Edinburgh Clinical Trials Unit, Western General Hospital, Edinburgh
  5. 5Primary Palliative Care Research Group, Community Health Sciences—General, Practice, University of Edinburgh

Abstract

Introduction Patients with advanced heart disease typically have a poor prognosis despite optimal cardiac therapy. These patients and families rarely receive coordinated holistic assessment and future care planning (FCP).

Aim(s) and method(s) This Marie Curie funded phase 2 trial seeks to explore whether a FCP intervention is acceptable, feasible and deliverable to patients (and families) with advanced heart disease following a recent unscheduled hospital admission. Patients with an unscheduled admission for acute coronary syndrome (ACS) or heart failure (HF) were screened using a prognostic scoring tool. Patients with a 12 month estimated mortality risk of 20% or greater were randomly allocated to either early (upon discharge) or delayed (after 12 weeks) FCP for 12 weeks. The FCP intervention combines holistic needs-assessment by a cardiologist with creation of a written/shared FCP and nurse-led care in the community. Primary outcome is quality of life of patients and carers assessed using questionnaires.

Results We recruited 50 patients (32 carers) – 22% with ACS, 68% HF and 10% valvular heart disease. There were 5 deaths and 5 withdrawals. For the whole cohort mean age is 81.1 years (SD=8.6), 60% male, mean Charlson comorbidity index was 4.2 (SD=1.7), median Canadian frailty scale=5 (Mildly frail). Intervention and follow up is currently on-going.

Conclusion(s) Findings demonstrate that the intervention and outcome measures were feasible and deliverable. Further analysis will provide invaluable information on the nature and feasibility of a larger clinical trial sufficiently powered to address hard clinical end-points.

  • Supportive care

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