Many heart patients miss out on earlier palliative care

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Heart disease is the leading cause of death in the US, but relatively few heart patients receive a referral to palliative care, according to a new study.

When heart patients receive a palliative care referral, they are typically near death and therefore benefit more from hospice services geared to end-of-life, researchers say. Palliative care focuses on quality of life and value-based treatment decisions.

“Hospice care is a subset of palliative care that is generally provided when a patient has about six months left to live,” says Haider J. Warraich, a cardiology fellow at Duke University and lead author of the study in JAMA Network Open.

“Palliative care is much broader, focusing on improving quality of life, easing pain and suffering, and assuring that the patients’ treatments going forward are in line with their values and goals,” Warraich says. “There’s a huge gap that patients with heart disease face that has resulted in them not receiving this type of care.”

For the study, Warraich and senior author, Arif Kamal, a palliative care specialist at Duke Cancer Institute, reviewed referrals to palliative care from a large national database to determine when and how often patients with cardiovascular disease received palliative care referrals.

The study included more than 1,800 patients with heart disease who received a referral for palliative care from 2015-2017. Of those, about 29 percent were bed-bound in the late stages of disease. By comparison, only about 10 percent of cancer patients, the largest group referred to palliative care, are bed-bound.

General medicine physicians increased referrals of heart patients to palliative care, from 43.2 percent in 2015 to 52.9 percent in 2017. The proportion of referrals from cardiologists declined, however, from 16.5 percent in 2015 to 10.5 percent in 2017.

“Our data highlight the enormous potential for increased partnerships between cardiologists and palliative care specialists in providing comprehensive, high-touch, supportive care to all affected by advanced heart disease,” Kamal says.

Additional researchers from Duke contributed to the work.

Source: Duke University