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O-96 Phase 2 randomised controlled trial of future care planning in patients with advanced heart disease
  1. Martin 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. Scott A Murray5
  1. 1Edinburgh Heart Centre, Royal Infirmary of Edinburgh, UK
  2. 2Department of Palliative Care, Royal Infirmary of Edinburgh, UK
  3. 3University of Edinburgh, School of Clinical Sciences
  4. 4Edinburgh Clinical Trials Unit, Western General Hospital, Edinburgh, UK
  5. 5Primary Palliative Care Research Group, Community Health Sciences General Practice, University of Edinburgh, UK

Abstract

Background Patients with advanced heart disease typically have poor prognosis despite optimal therapy and rarely receive coordinated future care planning (FCP).

Aim 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.

Methods Patients with acute coronary syndrome (ACS) or acute 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 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 50 patients (and 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.

Discussion Findings demonstrate that the intervention and outcome measures were feasible and deliverable. Further analysis be presented at the meeting.

Conclusion Future Care planning represents a key generic mechanism by which patients with advanced heart disease can begin planning for a good death. Randomised trial evidence is one approach by which this could be adopted into routine clinical practice in a socialised healthcare system.

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