Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia; Department of Palliative Care, Alfred Hospital, Melbourne, Vic, Australia.
Heart Lung Circ. 2024 Jul;33(7):1058-1066. doi: 10.1016/j.hlc.2024.01.022. Epub 2024 Mar 8.
Heart failure (HF) has high mortality and healthcare utilisation. It has a complex and unpredictable trajectory, which is often interpreted as a barrier to guideline recommended early integration of palliative care (PC). In particular, lack of referral criteria and misconceptions around PC affect inpatient specialist PC referrals.
The main objective was to characterise the pattern and predictors of referral of HF patients to the specialist inpatient PC consultative service at our healthcare service.
A retrospective, single-centre cohort study was performed on consecutive patients admitted across the hospital with HF over a 12-month period (July 2019-June 2020). Mortality data were checked against state death registry data.
The 502 patients admitted for HF were elderly (mean age 78±14 years), had high dependency (54% Australian-modified Karnofsky Performance Status (AKPS) 50-70, 29% AKPS 10-40), and high mortality (53% within median 32 months at death registry data linkage). Seven per cent (7%) were referred to inpatient specialist PC. AKPS 10-40 (62% of those referred vs 26% not referred, p<0.01), reliance on carers (65% vs 36%, p<0.01), and New York Heart Association (NYHA) class III-IV symptoms (86% vs 42%, p<0.01) were associated with referral, but two or more admissions in the last 12 months for HF were not (16% vs 10%, p=0.21). Many PC domains, such as symptom burden, distress, and preferred care, were not adequately assessed.
Referral to inpatient specialist PC in hospitalised HF patients is low relative to the morbidity and mortality in these patients.
心力衰竭（HF）的死亡率和医疗保健利用率都很高。它具有复杂且不可预测的病程，这通常被解释为阻碍指南推荐尽早整合姑息治疗（PC）的一个因素。特别是，缺乏转诊标准以及对 PC 的误解会影响住院专科 PC 的转诊。
本研究的主要目的是描述我们医疗服务中心收治的 HF 患者向专科住院 PC 会诊服务转诊的模式和预测因素。
这是一项回顾性、单中心队列研究，对在医院因 HF 住院的连续患者进行了研究，研究时间为 12 个月（2019 年 7 月至 2020 年 6 月）。对死亡率数据与州死亡登记数据进行了核对。
502 例因 HF 入院的患者年龄较大（平均年龄 78±14 岁），病情较重（54%的澳大利亚改良卡诺夫斯基表现状态（AKPS）评分为 50-70，29%的 AKPS 评分为 10-40），死亡率较高（中位死亡时间为 32 个月，在死亡登记数据链接时的死亡率为 53%）。7%的患者被转诊至住院专科 PC。AKPS 评分为 10-40（转诊患者中占 62%，未转诊患者中占 26%，p<0.01）、依赖护理人员（65% vs 36%，p<0.01）以及 NYHA 心功能 III-IV 级症状（86% vs 42%，p<0.01）与转诊相关，但过去 12 个月内因 HF 住院两次或以上的患者则没有（16% vs 10%，p=0.21）。许多 PC 领域，如症状负担、痛苦和首选治疗，都没有得到充分评估。
与这些患者的发病率和死亡率相比，住院 HF 患者向专科住院 PC 转诊的比例较低。
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