Division of Cardiology, Department of Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Medicine, 6595Veterans Health Administration Pittsburgh Health System, Pittsburgh, PA, USA.
Am J Hosp Palliat Care. 2021 Jul;38(7):807-811. doi: 10.1177/1049909120963565. Epub 2020 Oct 5.
Determine the role of palliative care on terminal code status and setting of death for those with heart failure.
Although palliative care consultation (PCC) has increased for many conditions, PCC has not increased in those with cardiovascular disease. While it has been shown that the majority of those with heart failure die in medical facilities, the impact of PCC on terminal code status and setting of death requires further analysis.
Patients admitted with heart failure between 2014-2015 at an academic VA Healthcare System were reviewed. Primary outcome was terminal code status. Secondary outcomes included setting of death, hospice utilization, and mortality scores. Student t-testing and Chi-square testing were performed where appropriate.
334 patients were admitted with heart failure and had a median follow up time of 4.3 years. 196 patients died, with 122 (62%) receiving PCC and 74 (38%) without PCC. Patients were more likely to have terminal code statuses of comfort measures with PCC (OR = 4.6, p = 0.002), and less likely to be full code (OR = 0.09, p < 0.001). 146 patients had documented settings of death and were more likely to receive hospice services with PCC (OR 6.76, p < 0.001). A patient's chance of dying at home was not increased with PCC (OR 0.49, p = 0.07), but they were more likely to die with inpatient hospice (OR = 17.03; p < 0.001).
Heart failure patients who received PCC are more likely to die with more defined care preferences and with hospice services. This does not translate to dying at home.
确定姑息治疗对心力衰竭患者终末代码状态和死亡设定的作用。
尽管姑息治疗咨询（PCC）在许多情况下有所增加，但心血管疾病患者的 PCC 并未增加。虽然大多数心力衰竭患者都在医疗机构死亡，但姑息治疗对终末代码状态和死亡设定的影响仍需要进一步分析。
回顾了 2014-2015 年在一家学术退伍军人事务医疗保健系统因心力衰竭入院的患者。主要结局是终末代码状态。次要结局包括死亡设定、临终关怀利用和死亡率评分。适当情况下进行学生 t 检验和卡方检验。
334 例心力衰竭患者入院，中位随访时间为 4.3 年。196 例患者死亡，其中 122 例（62%）接受了 PCC，74 例（38%）未接受 PCC。接受 PCC 的患者更有可能处于舒适治疗的终末代码状态（OR=4.6，p=0.002），而不太可能是全面代码（OR=0.09，p<0.001）。146 例患者有记录的死亡设定，接受 PCC 的患者更有可能接受临终关怀服务（OR=6.76，p<0.001）。接受 PCC 的患者在家中死亡的机会并没有增加（OR=0.49，p=0.07），但他们更有可能在住院临终关怀中死亡（OR=17.03；p<0.001）。
接受 PCC 的心力衰竭患者更有可能在临终关怀服务的支持下，按照更明确的护理偏好死亡。但这并不意味着他们会在家中死亡。
