SUPPORTIVE CARE IN HEART FAILURE: ESTABLISHING A NEW INTEGRATIVE CARE INITIATIVE
CCC ePoster Library. Nguyen Q. 10/26/19; 280524; 289
Quynh Nguyen
Quynh Nguyen
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Abstract
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BACKGROUND: Supportive care (SC) is an under-utilized resource for heart failure (HF) patients. Given the symptom burden experienced by HF patients, they would greatly benefit from SC. However, there is a big gap between demand and services when it comes to SC for HF patients. The most challenging barrier to integrating SC in HF patient care is patient screening. Various screening tools were evaluated for their predictive value, and a summary score < 29 on the Kansas City Cardiomyopathy Questionnaire (KCCQ) was the strongest predictor of subsequent SC need.

METHODS AND RESULTS: HF patients with SC needs were identified using a KCCQ summary score < 29 as the cut-off. Patient demographic and baseline clinical characteristics including medical history, discharge medication, laboratory results and echocardiography parameters were compared between patients with and without SC needs. Patients with SC needs were referred to and followed up at our SC clinic (SCC). Outcomes in terms of home care access, goals of care (GOC) changes, implantable cardioverter defibrillator (ICD) deactivation and hospitalization at end-of-life were measured for those referred to SC services. SC needs was identified in 41 patients (9%), among 456 who completed the KCCQ. Demographics were similar between the two groups of patients, except patients with SC needs have significantly higher BMIs and have more severe NYHA classes. Mineralocorticoid receptor antagonists (MRAs) were used more frequently in patients without SC needs. Of those with SC needs, 22 were referred to SC services: 2 passed away before being seen, 1 refused SC and 19 were seen at the SCC. Of these 19, 10 passed away and 9 are currently followed. All patients were referred to home care, and 53% changed their GOC to care focused on symptom control and comfort. One patient had their ICD deactivated. The median number of emergency department visit/hospitalization post-SC consultation is 1 (IQR: 0-2). Median survival after SC initiation is 3 months, with patients spending less than a month to 11 months before passing away. Of the 10 patients that passed away, 2 passed away at the emergency department, 1 at the internal medicine unit, 4 at home and 3 at hospital palliative care units.

CONCLUSION: There is clearly an unmet need for SC among HF patients. A KCCQ summary score < 29 is useful for identifying patients with SC needs in routine clinical practice. Incorporating SC into cardiac care for HF patients is essential to improve their quality of life.
BACKGROUND: Supportive care (SC) is an under-utilized resource for heart failure (HF) patients. Given the symptom burden experienced by HF patients, they would greatly benefit from SC. However, there is a big gap between demand and services when it comes to SC for HF patients. The most challenging barrier to integrating SC in HF patient care is patient screening. Various screening tools were evaluated for their predictive value, and a summary score < 29 on the Kansas City Cardiomyopathy Questionnaire (KCCQ) was the strongest predictor of subsequent SC need.

METHODS AND RESULTS: HF patients with SC needs were identified using a KCCQ summary score < 29 as the cut-off. Patient demographic and baseline clinical characteristics including medical history, discharge medication, laboratory results and echocardiography parameters were compared between patients with and without SC needs. Patients with SC needs were referred to and followed up at our SC clinic (SCC). Outcomes in terms of home care access, goals of care (GOC) changes, implantable cardioverter defibrillator (ICD) deactivation and hospitalization at end-of-life were measured for those referred to SC services. SC needs was identified in 41 patients (9%), among 456 who completed the KCCQ. Demographics were similar between the two groups of patients, except patients with SC needs have significantly higher BMIs and have more severe NYHA classes. Mineralocorticoid receptor antagonists (MRAs) were used more frequently in patients without SC needs. Of those with SC needs, 22 were referred to SC services: 2 passed away before being seen, 1 refused SC and 19 were seen at the SCC. Of these 19, 10 passed away and 9 are currently followed. All patients were referred to home care, and 53% changed their GOC to care focused on symptom control and comfort. One patient had their ICD deactivated. The median number of emergency department visit/hospitalization post-SC consultation is 1 (IQR: 0-2). Median survival after SC initiation is 3 months, with patients spending less than a month to 11 months before passing away. Of the 10 patients that passed away, 2 passed away at the emergency department, 1 at the internal medicine unit, 4 at home and 3 at hospital palliative care units.

CONCLUSION: There is clearly an unmet need for SC among HF patients. A KCCQ summary score < 29 is useful for identifying patients with SC needs in routine clinical practice. Incorporating SC into cardiac care for HF patients is essential to improve their quality of life.
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