Palliative Care as a Predictor of Mortality in Heart Failure Patients
Heart failure (HF) is a terrible and costly disease with high morbidity and mortality rates. However, patients who die from heart failure are often not prepared for their own death, and physicians are unable to assist them by predicting when they might die. Previous studies have indicated that predicting mortality is challenging, time-consuming and often inaccurate. The current study is novel because it examines short-term mortality after hospital discharge in patients with HF using easily accessible clinical characteristics including previous medical history, mental status and functional status.
In this prospective, cohort study we examined the patient characteristics of 386 patients with HF at an academic urban medical center, to identify patients at risk for dying within 30 and 90 days after hospital discharge.
Methods and Results
Using multiple logistic regression, patients with preserved systolic function (p<.04 ) and with no history of coronary artery disease (p<.05) were at high risk of death within 30 days after discharge. Consultation with Palliative Care services was the most powerful predictor of mortality at 30 and 90 days after discharge. No clinical or demographic variables correlated highly with Palliative Care consultations.
Patients who received consultations from Palliative Care services were the most likely to die at 30 and 90 days after hospital discharge. Clinicians accurately identify patients with HF who are at highest risk of dying in the near term using non-quantifiable attributes.