Congestive heart failure (CHF) is a leading cause of hospitalization nationwide in people over more than 65. Moreover, CHF exacerbation is one of the leading causes of readmission creating a substantial financial burden on the health care system. Unlike oncology patients, those with endstage CHF are not commonly referred to hospice or palliative care as it can be difficult to identify patients with a poor prognosis because the trajectory of CHF can be highly variable. Previous studies have identified independent predictors of 6month mortality in patients hospitalized for CHF exacerbation. These variables can be made into a simplified prognostication model which can help identify patients with a high likelihood for 6month mortality.
To assess the rate of palliative care and hospice referrals in hospitalized CHF patients using traditional models and a fouritem risk score on admission. Also, to improve the proportion of appropriate palliative care referrals, and assess rates of hospital readmission.
Using a fouritem risk score on admission (one point each for a BUN of 30 mg/dL or greater, systolic blood pressure less than 120 mmHg, history of peripheral vascular disease and a serum sodium less than 135 mEq/L), we aimed to: (1) Identify patients admitted for CHF exacerbation who would be appropriate candidates for palliative care referral, (2) improve the proportion of appropriate patients referred to palliative care and, (3) ultimately, decrease the number of CHF readmissions. Previous studies have shown that patients who meet 3 or more of the above criteria have a 6month mortality of 67%. Retrospectively, data was collected looking at referrals made to palliative care and hospice at our hospital from January 2009 to 2010 using the fouritem risk model and more traditional models (CHF stage and NYHA class). Our initial data demonstrated that 44% of patients meeting 3 or more criteria from the fouritem risk model, and only 20% of patients with NYHA class equal to or greater than 3 were referred to hospice or palliative care. This data was presented to the house staff, cardiologists, palliative care staff and the hospitalist group. Approval was granted for implementation of the fouritem risk model into the CHF admission orderset. The modified admission orderset now has a required option for palliative care consultation which is strongly recommended for patients with a class IIIIV or stage D CHF (at compensated baseline), or a score of three or more on the fouritem risk score model.
This project’s goal is to increase the number and proportion of appropriate palliative care referrals in patients with endstage CHF using a simplified prognostication model. Other things which will be assessed include number of CHF readmissions and JHACO core measure adherence.
To cite this abstract:Olson A, Bowman D, Risser J, Skarda P, Lick S, Kaplan Y. Palliative Care Referral of Hospitalized Congestive Heart Failure Patients. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97720. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/palliative-care-referral-of-hospitalized-congestive-heart-failure-patients/. Accessed March 20, 2019.