Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Assessing the final year of HF patients before death: why we must strive for better end-of-life care
Session:
Posters (Sessão 3 - Écran 5) - Insuficiência Cardíaca - Clínica
Speaker:
Sérgio Maltês
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Sérgio Maltês; Maria Rita Lima; Mariana Sousa Paiva; Bruno ML Rocha; Gonçalo JL Cunha; Catarina Brízido; Christopher Strong; António Tralhão; António Ventosa; Carlos Aguiar; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Despite significant improvements in heart failure (HF) treatment, mid-to-long term prognosis remains grim for many. Optimal HF care must rely not only on disease-modifying strategies that strive to improve outcomes but also on palliative care for those at their end-of-life period. Indeed, the last-months of life HF patients´ may be burdened with recurrent hospitalizations and invasive interventions, potentially leading to further patient suffering. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Goal</u>: to characterize the final year of life of HF patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methodology</u><span style="color:#222222">: Single-center retrospective cohort of HF patients previously followed in an outpatient setting and died between 2018-2021. Those with sudden cardiac death were excluded, as were those who died in another hospital. Terminal HF was defined as advanced HF (as per 2018 HFA-ESC updated criteria) with contraindications for heart transplantation or long-term left ventricle assistance device referral.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: 81 patients were included (mean age at time of death 68±14 years, mean LVEF 31±14%, median NT-proBNP 3346 (1277-6983) pg/mL; 42% with an HF-related cause of death), most with a significantly reduced functional capacity (56% in NYHA class III or IV; median pVO<sub>2 </sub>[available in 59 patients] of 12.5 [10.2-14.5]mL/kg/min). Twenty-seven patients (33%) met criteria for terminal HF. Overall, a high burden of hospitalizations (53% with two or more hospitalizations) were observed and associated with prolonged durations of stay (15 [3-45] days; 31% with ≥30 days hospitalized). A significant number of patients underwent invasive interventions during their final year (49% performed coronary or structural cardiac intervention, 44% had a electric device implanted). Only a minority of patients were followed in an outpatient HF clinic (12 patients, 15%) or were referred for structured palliative care (5 patients, 6%). Among those with terminal HF, a clear DNR order was registered in only 34% of medical records. Implantable cardioverter-defibrillator therapies were discontinued in only half of these patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: HF remains a complex syndrome that leads to an unrelenting functional decline and a high burden for health-care systems, especially among those reaching their end-of-life period. Yet, a high proportion of HF patients still undergoes invasive interventions during their final year, likely reflecting clinicians’ difficulty in appropriately predicting patient outcomes and life expectancy. New tools to better stratify patient prognosis, as well as understanding and implementing appropriate end-of-life care is of utmost importance and must be recognized by all that treat HF patients.</span></span></span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site