Increasing Palliative Consults for Heart Failure Inpatients Using the Seattle Heart Failure Model

Palliative Care Consultations for Heart Failure Patients: How Many, When, and Why?

“…43 In our cohort, at the time of the initial PCC the median SHFM predicted 1 year mortality was only 29% and the calculated median life expectancy was 2.8 years. However the actual median survival time from consultation until death was only 21 days indicating gross imprecision of the SHFM score estimates in a more seriously ill population.The finding is not without precedent: for example, James et al 29 retrospectively applied the SHFM at admission and discharge to a cohort of 214 HF patients to determine who might have benefited from a palliative care referral based on a predicted life expectancy ≤1.5 years. They concluded that 63% (n = 17) of the 27 “poor prognosis” patients would have been appropriately identified for PCC.…”

Transitional Care Programs Improve Outcomes for Heart Failure Patients

“…Components of CHD, such as hypertension, previous myocardial infarction, history of valvular insufficiency, diabetes, and obesity, place individuals at risk for heart failure (HF). 5 Furthermore, HF has been estimated to affect 10 per 1000 individuals after 65 years of age and 1 in 5 will develop HF after 40 years of age. 4 It affects about 5.8 million individuals, with associated health expenditures estimated at $33.7 billion in the United States.…”

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

“…2,[12][13][14][15] This seems logical, since persons with advanced HF and their families, like patients with cancer, bear the brunt of unaddressed physical pain and emotional suffering, face a number of complex and difficult medical decisions, 2 and weather multiple hospitalizations in their last year of life. 7,9,[16][17][18][19][20][21] Initiation of interdisciplinary palliative care services beginning early in the course of advanced HF has been strongly recommended as a critical strategy in addressing these challenges by professional groups 6,15,19,[25][26][27][28][29] including the AHA 25 and many others. 5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges.…”

“…In addition, patients receive an in-person PC team assessment based on National Consensus Project PC guidelines. 22 ENABLE [21][22][23] is the first successful PC intervention in the rural advanced cancer population to apply Wagner's Chronic Illness Care (CIC) model, [24][25][26][27][28][29][30] which shifted the cancer care paradigm by introducing concurrent PC earlier in the disease trajectory (see Fig. 3).…”