Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care

Authors

Yuchieh Kathryn Chang, Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Larry A. Allen, University of Colorado School of Medicine, Aurora, Colorado, USA.Follow
John A. McClung, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.Follow
Martin A. Denvir, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Jennifer Philip, Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia.
Masanori Mori, Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Pedro Perez-Cruz, Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Shao-Yi Cheng, Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
Anna Collins, Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia.
David Hui, Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address: dhui@mdanderson.org.

Author Type(s)

Faculty

DOI

10.1016/j.jacc.2022.04.057

Journal Title

Journal of the American College of Cardiology

First Page

332

Last Page

344

Document Type

Article

Publication Date

7-26-2022

Department

Medicine

Abstract

BACKGROUND: Patients with advanced heart failure have substantial supportive care needs. Specialist palliative care can be beneficial, but it is unclear who is most appropriate for referral and when patients should be referred. OBJECTIVES: We conducted a Delphi study of international experts to identify consensus referral criteria for specialist palliative care for patients with advanced heart failure. METHODS: Clinicians from 5 continents with expertise in the integration of cardiology and palliative care were asked to rate 34 disease-based, 24 needs-based, and 9 time-based criteria over 3 rounds. Consensus was defined a priori as ≥70% agreement. A criterion was coded as major if the experts endorsed that meeting that criterion alone was adequate to justify a referral. RESULTS: The response rate was 44 of 46 (96%), 41 of 46 (89%), and 43 of 46 (93%) in the first, second, and third rounds, respectively. Panelists reached consensus on 25 major criteria for specialist palliative care referral. The 25 major criteria were categorized under 6 topics, including "advanced/refractory heart failure, comorbidities, and complications" (eg, cardiac cachexia, cardiorenal syndrome) (n = 8), "advanced heart failure therapies" (eg, chronic inotropes, precardiac transplant) (n = 4), "hospital utilization" (eg, emergency room visits, hospitalization) (n = 2), "prognostic estimate" (n = 1), "symptom burden/distress" (eg, severe physical/emotional/spiritual distress) (n = 6), and "decision making/social support" (eg, goals-of-care discussions) (n = 4). The majority (68%) of major criteria had ≥90% agreement. CONCLUSIONS: International experts reached consensus on a large number of criteria for referral to specialist palliative care. With further validation, these criteria may be useful for standardizing palliative care access in the inpatient and/or outpatient settings.

Recommended Citation

Chang, Y. K., Allen, L. A., McClung, J. A., Denvir, M. A., Philip, J., Mori, M., Perez-Cruz, P., Cheng, S., Collins, A., & Hui, D. (2022). Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care. Journal of the American College of Cardiology, 80 (4), 332-344. https://doi.org/10.1016/j.jacc.2022.04.057