TY - JOUR
T1 - Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care
AU - Chang, Yuchieh Kathryn
AU - Allen, Larry A.
AU - McClung, John A.
AU - Denvir, Martin A.
AU - Philip, Jennifer
AU - Mori, Masanori
AU - Perez-Cruz, Pedro
AU - Cheng, Shao Yi
AU - Collins, Anna
AU - Hui, David
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7/26
Y1 - 2022/7/26
N2 - 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.
AB - 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.
KW - Delphi technique
KW - heart failure
KW - palliative care
KW - patient selection
KW - referral and consultation
KW - supportive care
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U2 - 10.1016/j.jacc.2022.04.057
DO - 10.1016/j.jacc.2022.04.057
M3 - Article
C2 - 35863850
AN - SCOPUS:85133882747
SN - 0735-1097
VL - 80
SP - 332
EP - 344
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -