Background The National Heart Foundation and the Cardiac Society of Australia and New Zealand recommended referral to palliative care for all patients with advanced heart failure in 2018.

In 2020, a Cardiac Supportive care Service (CSCS) was developed, pairing a palliative medicine physician and a cardiology nurse practitioner to provide home based community visits to patients with heart failure. Patients were then reviewed on subsequent inpatient admissions. This embedded care model promotes bidirectional learning, trust and possible ‘fringe benefits’ to all patients with heart failure. This study aims to explore the impact of an CSCS on numbers of inpatient referrals, to describe this patient cohort and conduct a death review for cardiology inpatients pre and post the CSCS.

Methods All inpatient referrals were prospectively collected for 12 months and compared to historical referral data. Demographics, previous referral to CSCS and rates of ceilings of care documentation and separations were collected.

All deaths admitted under the Cardiology Service in the year pre and 3 years post were reviewed. Deaths in the intensive care unit or cardiac catheter lab and perioperative deaths were excluded. Ceilings of care, delivery of cardiopulmonary resuscitation (CPR) and involvement with palliative care during the admission were recorded.

Results From June 2023- May 2024 there were 122 inpatient referrals to the CSCS. Compared an annual average of 34 referrals to palliative care (2010- 2020) and 56 in the first 12 months of CSCS. Mean age 83 years (37–102yr), 56% male and 22% (27/122) were known to the community CSCS prior. Ceilings of care were documented during the admission in 95%(116/122) and 26% (32/122) died during the admission.

The year prior to CSCS (2019) there were 21 ward deaths under cardiology with 24% (5/21) receiving CPR (mean age 85yrs (76–92yr)), 76% had documented ceilings of care and 66% were known to the palliative care service prior to death. Three years after CSCS began (2023), 8% (3/37) received CPR with the mean age of 63yrs (range 57–69yrs) All inpatients over the age of 75 years had documented ceilings of care, and 84% were known to CSCS or Palliative care prior to death.

Discussion The introduction of a community based CSCS has lead to a nearly 4 fold increase in cardiology inpatient referrals to CSCS/palliative care. The majority of these referrals were not previously known to CSCS and most had ceilings of care documented. When reviewing cardiology ward deaths pre and post CSCS, there was less CPR attempted, more ceilings of care documented and more CSCS/palliative care involvement prior to death following the introduction of CSCS.