Yuchieh Kathryn Chang1, Holland Kaplan1, Yimin Geng2, Li Mo1,3, Jennifer Philip4,5, Anna Collins4, Larry A Allen6, John A McClung7, Martin A Denvir8, David Hui1. 1. Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX. 2. Research Medical Library (Y.G.), The University of Texas MD Anderson Cancer Center, Houston, TX. 3. Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China (L.M.). 4. Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia (J.P., A.C.). 5. Royal Melbourne Hospital, Parkville, Australia (J.P.). 6. University of Colorado School of Medicine, Aurora (L.A.A.). 7. Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York (J.A.M.). 8. Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (M.A.D.).
Abstract
BACKGROUND: Patients with heart failure have significant symptom burden, care needs, and often a progressive course to end-stage disease. Palliative care referrals may be helpful but it is currently unclear when patients should be referred and by whom. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with heart failure. METHODS: We searched Ovid, MEDLINE, Ovid Embase, and PubMed databases for articles in the English language from the inception of databases to January 17, 2019 related to palliative care referral in patients with heart failure. Two investigators independently reviewed each citation for inclusion and then extracted the referral criteria. Referral criteria were then categorized thematically. RESULTS: Of the 1199 citations in our initial search, 102 articles were included in the final sample. We identified 18 categories of referral criteria, including 7 needs-based criteria and 10 disease-based criteria. The most commonly discussed criterion was physical or emotional symptoms (n=51 [50%]), followed by cardiac stage (n=46 [45%]), hospital utilization (n=38 [37%]), prognosis (n=37 [36%]), and advanced cardiac therapies (n=36 [35%]). Under cardiac stage, 31 (30%) articles suggested New York Heart Association functional class ≥III and 12 (12%) recommended New York Heart Association class ≥IV as cutoffs for referral. Prognosis of ≤1 year was mentioned in 21 (21%) articles as a potential trigger; few other criteria had specific cutoffs. CONCLUSIONS: This systematic review highlighted the lack of consensus regarding referral criteria for the involvement of palliative care in patients with heart failure. Further research is needed to identify appropriate and timely triggers for palliative care referral.
BACKGROUND:Patients with heart failure have significant symptom burden, care needs, and often a progressive course to end-stage disease. Palliative care referrals may be helpful but it is currently unclear when patients should be referred and by whom. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with heart failure. METHODS: We searched Ovid, MEDLINE, Ovid Embase, and PubMed databases for articles in the English language from the inception of databases to January 17, 2019 related to palliative care referral in patients with heart failure. Two investigators independently reviewed each citation for inclusion and then extracted the referral criteria. Referral criteria were then categorized thematically. RESULTS: Of the 1199 citations in our initial search, 102 articles were included in the final sample. We identified 18 categories of referral criteria, including 7 needs-based criteria and 10 disease-based criteria. The most commonly discussed criterion was physical or emotional symptoms (n=51 [50%]), followed by cardiac stage (n=46 [45%]), hospital utilization (n=38 [37%]), prognosis (n=37 [36%]), and advanced cardiac therapies (n=36 [35%]). Under cardiac stage, 31 (30%) articles suggested New York Heart Association functional class ≥III and 12 (12%) recommended New York Heart Association class ≥IV as cutoffs for referral. Prognosis of ≤1 year was mentioned in 21 (21%) articles as a potential trigger; few other criteria had specific cutoffs. CONCLUSIONS: This systematic review highlighted the lack of consensus regarding referral criteria for the involvement of palliative care in patients with heart failure. Further research is needed to identify appropriate and timely triggers for palliative care referral.
Entities:
Keywords:
consensus; heart failure; palliative care; prognosis; referral and consultation
Authors: Laura M Yamokoski; Vic Hasselblad; Debra K Moser; Cynthia Binanay; Ginger A Conway; Jana M Glotzer; Karen A Hartman; Lynne W Stevenson; Carl V Leier Journal: J Card Fail Date: 2007-02 Impact factor: 5.712
Authors: Rachel Wells; Macy L Stockdill; J Nicholas Dionne-Odom; Deborah Ejem; Kathryn L Burgio; Raegan W Durant; Sally Engler; Andres Azuero; Salpy V Pamboukian; Jose Tallaj; Keith M Swetz; Elizabeth Kvale; Rodney O Tucker; Marie Bakitas Journal: Trials Date: 2018-08-06 Impact factor: 2.279
Authors: Li Mo; Yimin Geng; Yuchieh Kathryn Chang; Jennifer Philip; Anna Collins; David Hui Journal: J Am Geriatr Soc Date: 2021-03-02 Impact factor: 7.538