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Identifying patients with chronic heart failure who may benefit from palliative care: a comparison of the Gold Standards Framework with a clinical prognostic mode
  1. K K Haga1,
  2. M A Denvir2,
  3. J Reid3,
  4. A Ness3,
  5. M O'Donnell3,
  6. D Yellowlees3 and
  7. S A Murray4
  1. 1School of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  2. 2Centre for Cardiovascular Science, NHS Lothian, Edinburgh, UK
  3. 3Heart Failure Nursing Service, NHS Lothian, Edinburgh, UK
  4. 4Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, UK


Introduction Heart failure has a worse survival rate than many cancers, yet few patients receive palliative care. The aim of this project was to evaluate the use of Gold Standards Framework (Seattle Heart Failure (SHF)) criteria and the SHF Model in patients with heart failure.

Methods Chronic heart failure patients, in NYHA class III or IV, who were being managed by a heart failure nursing service, were identified. The GSF criteria were assessed by interviewing the specialist nurse responsible for each patient's care. The SHF data were used to estimate mean life expectancy and predicted mortality at 1 year. Patients were followed up after 1 year, to evaluate; (1) all-cause mortality and (2) the sensitivity and specificity of the GSF and SHF to predict death at 1 year.

Results 138 patients were identified through our search. GSF criteria identified 119/138 (86%) patients that met the minimum requirement for palliative care input. However, the SHF model predicted that only 6/138 patients (4.3%) had a predicted life expectancy of less than 1 year. At follow-up, 43/138 patients had died (31%). The sensitivity and specificity for the GSF and SHF model were 22%/83% and 98%/12% respectively.

Discussion Neither the GSF nor the SHF accurately predicted which patients were in the last year of life. The implementation of palliative care in heart failure patients may require a shift away from the traditional ‘end of life’ model used in cancer, and focus on the patient's increasing needs, understanding that death, itself, may remain unpredictable.

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