Research article

Provision of palliative care for chronic heart failure inpatients: how much do we need?

Richard Harding¹ , Teresa Beynon² , Fiona Hodson³ , Elaine Coady³ , Mark Kinirons⁴ , Lucy Selman¹ and Irene Higginson¹

¹Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK

²Department of Palliative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK

³Heart Failure Service, Guy's and St Thomas' NHS Foundation Trust, London, UK

⁴Elderly Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK

author email corresponding author email

BMC Palliative Care 2009, 8:8doi:10.1186/1472-684X-8-8

Published:	29 June 2009

Abstract

Background

Clinical guidance recommends early CHF palliative care intervention, but the magnitude of need is unknown and evidence-based referral criteria absent.

This study aimed to: 1) Measure point prevalence of inpatients appropriate for palliative care. 2) Identify patient characteristics associated with palliative care appropriateness. 3) Propose evidence-based clinical referral criteria.

Methods

Census: all adult medical inpatient files in a UK tertiary teaching hospital were reviewed, identifying patients with CHF as a reason for current admission, using NYHA stage 3/4 classification, cross referenced with existing ECHO data. Each CHF patient was classified according to appropriateness for palliative care against a definition of unresolved pain and/or symptoms and/or psychosocial problems 7 days post admission.

Results

Three hundred and sixty-five patient files were reviewed, and 28 clinically identified as having CHF. Of these, 11 had confirmed unpreserved ejection fraction,16 of the 28 patients were appropriate for palliative care. Of the total inpatient population reviewed, 10 (2.7%) had both confirmed ejection fraction ≤45%, and were appropriate for palliative care. Of the 17 clinically-identified CHF patients with no recorded evidence of ejection fraction ≤45%, 5 (29.4%) were still appropriate for palliative care. A total of 4.4% of the reviewed inpatient population had a clinical diagnosis of CHF and were appropriate for palliative care.

Conclusion

CHF patients with ejection fraction >45% also require palliative care. Our conservative criteria suggest a point prevalence of 2.7% of patients having both ejection fraction ≤45% and palliative care needs, although this may be a conservative estimate due to the file review methodology to identify unresolved palliative care problems. It is important to note that the point prevalence of patients with clinical diagnosis and palliative care needs was 4.4% of the population. We present evidence-based referral criteria from the larger multi methods study.