Palliative care integration into outpatient heart failure management: pilot study

Objectives People with heart failure have palliative care needs yet services remain underused. The heart failure clinic is a potential setting for initial palliative care delivery though evidence for such services is lacking. We explored the outcomes of an embedded model of palliative medicine within a heart failure clinic. Methods We conducted a retrospective cohort study of individuals who received a palliative medicine consultation in a heart failure clinic. Descriptive statistics were used to characterise the cohort and their outcomes, and the McNemar test to compare rates of advance care planning before/after consultation. Results Majority of individuals who received a palliative medicine consultation experienced New York Heart Association (NYHA) class II symptoms (65.5%) and had a Palliative Performance Scale score of >= 60% (66.8%). While only 17% engaged in advance care planning in the year before consultation, 93% had advance care planning during the first consultation (p<0.001). Care was provided in multiple domains including advance care planning (95%), symptom management (97%) and caregiver support (30%), regardless of the reason for referral. Conclusions Our embedded model of palliative medicine within the heart failure clinic was associated with increased advance care planning at a time when patients were functional and minimally symptomatic. Further research should substantiate these findings at other sites.