Ejection fraction and palliative care appropriateness Eleven patients had both clinical diagnosis and confirmed ejection fraction ≤45%. A further 11 patients had chronic heart failure specified in their notes as a reason for their admission but had an ejection fraction of greater than 45%. Six were clinically Galunisertib cost identified as having CHF as a significant reason for admission by their ward medical staff during the census but had no ECHO data on file three months after the census date. Of the 17 patients with no supporting ECHO data (i.e. no ECHO result n = 6, or an ECHO result showing Inhibitors,research,lifescience,medical normal
function n = 11), five (29.4%) were identified as being appropriate for palliative care. Characteristics of patients appropriate for palliative care Those patients appropriate for palliative care had a mean of 5.1 unresolved symptoms and problems at 7 days Inhibitors,research,lifescience,medical post-admission. The characteristics of the following two groups were compared to the remaining patients with a clinical CHF diagnosis: a) those identified
as appropriate for palliative care irrespective of ECHO data, and b) those with ejection fraction ≤45% and palliative care appropriate. Compared to the remaining patients with a clinical CHF diagnosis (n = 12), those identified Inhibitors,research,lifescience,medical as palliative care appropriate (n = 16) had a statistically significant higher mean number of previous admissions (1.53 Inhibitors,research,lifescience,medical compared to 0.44, p = 0.024, t = -2.433); were being seen by a significantly greater number of multiprofessional inpatient staff (i.e. 2.1 staff compared to 0.9, P = 0.045, T = -2.169), and were significantly more likely to have a “do not resuscitate order” in their notes (43.8% compared
to 0%, p = 0.011, x2 = 6.497). Compared to all those remaining patients with a clinical diagnosis of CHF (n = 17), those with an ejection fraction ≤45% and appropriate for palliative care (n = 11) had a statistically significant Inhibitors,research,lifescience,medical higher mean number of previous admissions (1.9 compared to 0.57, p = 0.012, nearly t = -2.733). Discussion Given the challenges of decision-making regarding palliative care initiation for CHF patients due to movement between NYHA classification levels, the data describing characteristics associated with palliative care appropriateness is useful, particularly in the absence of ECHO data. The number of clinically identified CHF patients without ECHO data is indicative of the relevance of palliative care to all heart failure patients, including those elderly patients with normal systolic function, right sided heart failure and those with diastolic dysfunction. Limitations of the present study This data is likely to report a conservative estimate of the point prevalence of CHF inpatients appropriate for palliative care, i.e. 2.7% after confirmed ECHO data.