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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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2
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Chiu CC, Wu CM, Chien TN, Kao LJ, Li C, Chu CM. Integrating Structured and Unstructured EHR Data for Predicting Mortality by Machine Learning and Latent Dirichlet Allocation Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4340. [PMID: 36901354 PMCID: PMC10001457 DOI: 10.3390/ijerph20054340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
An ICU is a critical care unit that provides advanced medical support and continuous monitoring for patients with severe illnesses or injuries. Predicting the mortality rate of ICU patients can not only improve patient outcomes, but also optimize resource allocation. Many studies have attempted to create scoring systems and models that predict the mortality of ICU patients using large amounts of structured clinical data. However, unstructured clinical data recorded during patient admission, such as notes made by physicians, is often overlooked. This study used the MIMIC-III database to predict mortality in ICU patients. In the first part of the study, only eight structured variables were used, including the six basic vital signs, the GCS, and the patient's age at admission. In the second part, unstructured predictor variables were extracted from the initial diagnosis made by physicians when the patients were admitted to the hospital and analyzed using Latent Dirichlet Allocation techniques. The structured and unstructured data were combined using machine learning methods to create a mortality risk prediction model for ICU patients. The results showed that combining structured and unstructured data improved the accuracy of the prediction of clinical outcomes in ICU patients over time. The model achieved an AUROC of 0.88, indicating accurate prediction of patient vital status. Additionally, the model was able to predict patient clinical outcomes over time, successfully identifying important variables. This study demonstrated that a small number of easily collectible structured variables, combined with unstructured data and analyzed using LDA topic modeling, can significantly improve the predictive performance of a mortality risk prediction model for ICU patients. These results suggest that initial clinical observations and diagnoses of ICU patients contain valuable information that can aid ICU medical and nursing staff in making important clinical decisions.
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Affiliation(s)
- Chih-Chou Chiu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chung-Min Wu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Te-Nien Chien
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Ling-Jing Kao
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chengcheng Li
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chuan-Mei Chu
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
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3
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Chiu CC, Wu CM, Chien TN, Kao LJ, Li C, Jiang HL. Applying an Improved Stacking Ensemble Model to Predict the Mortality of ICU Patients with Heart Failure. J Clin Med 2022; 11:6460. [PMID: 36362686 PMCID: PMC9659015 DOI: 10.3390/jcm11216460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Cardiovascular diseases have been identified as one of the top three causes of death worldwide, with onset and deaths mostly due to heart failure (HF). In ICU, where patients with HF are at increased risk of death and consume significant medical resources, early and accurate prediction of the time of death for patients at high risk of death would enable them to receive appropriate and timely medical care. The data for this study were obtained from the MIMIC-III database, where we collected vital signs and tests for 6699 HF patient during the first 24 h of their first ICU admission. In order to predict the mortality of HF patients in ICUs more precisely, an integrated stacking model is proposed and applied in this paper. In the first stage of dataset classification, the datasets were subjected to first-level classifiers using RF, SVC, KNN, LGBM, Bagging, and Adaboost. Then, the fusion of these six classifier decisions was used to construct and optimize the stacked set of second-level classifiers. The results indicate that our model obtained an accuracy of 95.25% and AUROC of 82.55% in predicting the mortality rate of HF patients, which demonstrates the outstanding capability and efficiency of our method. In addition, the results of this study also revealed that platelets, glucose, and blood urea nitrogen were the clinical features that had the greatest impact on model prediction. The results of this analysis not only improve the understanding of patients' conditions by healthcare professionals but allow for a more optimal use of healthcare resources.
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Affiliation(s)
- Chih-Chou Chiu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chung-Min Wu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Te-Nien Chien
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Ling-Jing Kao
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chengcheng Li
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Han-Ling Jiang
- Alliance Manchester Business School, University of Manchester, Manchester M15 6PB, UK
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4
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Fagundes A, Berg DD, Bohula EA, Baird-Zars VM, Barnett CF, Carnicelli AP, Chaudhry SP, Guo J, Keeley EC, Kenigsberg BB, Menon V, Miller PE, Newby LK, van Diepen S, Morrow DA, Katz JN. End-of-life care in the cardiac intensive care unit: a contemporary view from the Critical Care Cardiology Trials Network (CCCTN) Registry. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:190-197. [PMID: 34986236 DOI: 10.1093/ehjacc/zuab121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
AIMS Increases in life expectancy, comorbidities, and survival with complex cardiovascular conditions have changed the clinical profile of the patients in cardiac intensive care units (CICUs). In this environment, palliative care (PC) services are increasingly important. However, scarce information is available about the delivery of PC in CICUs. METHODS AND RESULTS The Critical Care Cardiology Trials Network (CCCTN) Registry is a network of tertiary care CICUs in North America. Between 2017 and 2020, up to 26 centres contributed an annual 2-month snapshot of all consecutive medical CICU admissions. We captured code status at admission and the decision for comfort measures only (CMO) before all deaths in the CICU. Of 13 422 patients, 10% died in the CICU and 2.6% were discharged to palliative hospice. Of patients who died in the CICU, 68% were CMO at death. In the CMO group, only 13% were do not resuscitate/do not intubate at admission. The median time from CICU admission to CMO decision was 3.4 days (25th-75th percentiles: 1.2-7.7) and ≥7 days in 27%. Time from CMO decision to death was <24 h in 88%, with a median of 3.8 h (25th-75th 1.0-10.3). Before a CMO decision, 78% received mechanical ventilation and 26% mechanical circulatory support. A PC provider team participated in the care of 41% of patients who died. CONCLUSIONS In a contemporary CICU registry, comfort measures preceded death in two-thirds of cases, frequently without PC involvement. The high utilization of advanced intensive care unit therapies and lengthy times to a CMO decision highlight a potential opportunity for early engagement of PC teams in CICU.
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Affiliation(s)
- Antonio Fagundes
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - David D Berg
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Vivian M Baird-Zars
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Christopher F Barnett
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anthony P Carnicelli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Jianping Guo
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Ellen C Keeley
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Benjamin B Kenigsberg
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
| | - Venu Menon
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - P Elliott Miller
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - L Kristin Newby
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Sean van Diepen
- Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Jason N Katz
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Erikson AE, Puntillo KA, McAdam JL. Bereavement Experiences of Families in the Cardiac Intensive Care Unit. Am J Crit Care 2022; 31:13-23. [PMID: 34972855 DOI: 10.4037/ajcc2022859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Losing a loved one in the intensive care unit is associated with complicated grief and increased psychologic distress for families. Providing bereavement support may help families during this time. However, little is known about the bereavement experiences of families of patients in the cardiac intensive care unit. OBJECTIVE To describe the bereavement experiences of families of patients in the cardiac intensive care unit. METHODS In this secondary analysis, an exploratory, descriptive design was used to understand the families' bereavement experiences. Families from 1 cardiac intensive care unit in a tertiary medical center in the western United States participated. Audiotaped telephone interviews were conducted by using a semistructured interview guide 13 to 15 months after the patient's death. A qualitative, descriptive technique was used for data analysis. Two independent researchers coded the interview transcripts and identified themes. RESULTS Twelve family members were interviewed. The majority were female (n = 8, 67%), spouses (n = 10, 83%), and White (n = 10, 83%); the mean age (SD) was 58.4 (16.7) years. Five main themes emerged: (1) families' bereavement work included both practical tasks and emotional processing; (2) families' bereavement experiences were individual; (3) these families were resilient and found their own resources and coping mechanisms; (4) the suddenness of a patient's death influenced families' bereavement experiences; and (5) families' experiences in the intensive care unit affected their bereavement. CONCLUSIONS This study provided insight into the bereavement experiences of families of patients in the cardiac intensive care unit. These findings may be useful for professionals working with bereaved families and for cardiac intensive care units considering adding bereavement support.
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Affiliation(s)
- Alyssa E. Erikson
- Alyssa E. Erikson is an associate professor, California State University, Monterey Bay, California
| | - Kathleen A. Puntillo
- Kathleen A. Puntillo is a professor emeritus, University of California, San Francisco, California
| | - Jennifer L. McAdam
- Jennifer L. McAdam is a professor, Samuel Merritt University, San Mateo, California
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Multidisciplinary Team-Based Palliative Care for Heart Failure and Food Intake at the End of Life. Nutrients 2021; 13:nu13072387. [PMID: 34371897 PMCID: PMC8308898 DOI: 10.3390/nu13072387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life.
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Godfrey S, Sahoo A, Sanchez J, Fried J, Masoumi A, Brodie D, Takayama H, Uriel N, Takeda K, Nakagawa S. The Role of Palliative Care in Withdrawal of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. J Pain Symptom Manage 2021; 61:1139-1146. [PMID: 33137423 DOI: 10.1016/j.jpainsymman.2020.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT As the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases, decisions regarding withdrawal from VA-ECMO increase. OBJECTIVES To evaluate the clinical characteristics of patients withdrawn from VA-ECMO and the role of palliative care consultation in the decision. METHODS We retrospectively reviewed adult patients with cardiogenic shock requiring VA-ECMO at our institution, who were withdrawn from VA-ECMO between January 1, 2014 and May 31, 2019. The relationship between clinical characteristics and palliative care visits was assessed, and documented reasons for withdrawal were identified. RESULTS Of 460 patients who received VA-ECMO, 91 deceased patients (19.8%) were included. Forty-two patients (44.8%) had a palliative care consultation. The median duration on VA-ECMO was 4.0 days (interquartile range 8.8), and it was significantly longer for patients with palliative care consultation than those without (8.8 days vs. 2.0 days, P < 0.001). Among those with palliative care consultation, those with early consultation (within three days) had significantly shorter duration of VA-ECMO compared with those with late consultation (7.6 days vs. 13.5 days, t = 2.022, P = 0.008). Twenty-two (24.2%) had evidence of brain injury, which was significantly associated with patient age, number of comorbidities, duration of VA-ECMO, number of life-sustaining therapies, and number of palliative care visits (Wilks lambda 0.8925, DF 5,121, P = 0.016). Presence of brain injury was associated with fewer palliative care visits (t = 2.82, P = 0.006). CONCLUSION Shorter duration of VA-ECMO support and presence of brain injury were associated with fewer palliative care visits. Decisions around withdrawal of VA-ECMO support might be less complicated when patient's medical conditions deteriorate quickly or when neurological prognosis seems poor.
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Affiliation(s)
- Sarah Godfrey
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Aradhana Sahoo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph Sanchez
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin Fried
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Amirali Masoumi
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Brodie
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hiroo Takayama
- Division of Cardiac, Vascular, and Thoracic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiac, Vascular, and Thoracic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Shunichi Nakagawa
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Adult Palliative Care Services, Columbia University Irving Medical Center, New York, New York, USA.
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8
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Karkabi B, Khoury R, Zafrir B, Jaffe R, Adawi S, Lavi I, Schliamser JE, Flugelman MY, Shiran A. Causes of mortality in a department of cardiology over a 15-year period. IJC HEART & VASCULATURE 2020; 32:100692. [PMID: 33365383 PMCID: PMC7749373 DOI: 10.1016/j.ijcha.2020.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Abstract
Aims Over the last four decades, in-hospital mortality from acute coronary syndromes (ACS) has declined. We characterized the patients who died in our cardiovascular intensive care unit (CICU) over a 15-year period. Based on these data, we described the changing patient population in the CICU. Methods This retrospective study compared characteristics of patients who died in our CICU in 2005–6, 2013–4 and 2019. During these 5 years, 13,931 patients were hospitalized; 251 (1.8%) died. The mean age of the patients who died was 76 years, 144 (57%) were men. ACS was the leading cause of admission (93 patients, 37%), and 145 (58%) patients had a history of heart failure prior to hospitalization. The leading cause of death was cardiogenic shock in 104 (41%) patients, septic shock in 48 (19%) patients, and combined cardiogenic and septic shock in 31 (12%). Patients hospitalized in the later years of the study were significantly older (67.7, 69.0 and 70.5 years, 2005–6, 2013–4 and 2019, respectively, p < 0.02) but their medical characteristics did not differ significantly between the years examined. Conclusions The profile of the patients who died did not change significantly over the 15-year study period. Age of admitted patients was higher in later years of the study. The leading cause of admission was ACS and the leading causes of death were cardiogenic and septic shock. Based on our observations, additional skills should be added to the curriculum of cardiology, including the management of patients with multiorgan failure.
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Affiliation(s)
- Basheer Karkabi
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Razi Khoury
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ronen Jaffe
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Salim Adawi
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Jorge E Schliamser
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Avinoam Shiran
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Lee JD, Jennerich AL, Engelberg RA, Downey L, Curtis JR, Khandelwal N. Type of Intensive Care Unit Matters: Variations in Palliative Care for Critically Ill Patients with Chronic, Life-Limiting Illness. J Palliat Med 2020; 24:857-864. [PMID: 33156728 DOI: 10.1089/jpm.2020.0412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: It is not clear whether use of specialty palliative care consults and "comfort measures only" (CMO) order sets differ by type of intensive care unit (ICU). A better understanding of palliative care provided to these patients may help address heterogeneity of care across ICU types. Objectives: Examine utilization of specialty palliative care consultation and CMO order sets across several different ICU types in a multihospital academic health care system. Design: Retrospective cohort study using Washington State death certificates and data from the electronic health record. Setting/Subjects: Adults with a chronic medical illness who died in an ICU at one of two hospitals from July 2013 through December 2018. Five ICU types were identified by patient population and attending physician specialty. Measurements: Documentation of a specialty palliative care consult during a patient's terminal ICU stay and a CMO order set at time of death. Results: For 2706 eligible decedents, ICU type was significantly associated with odds of palliative care consultation (p < 0.001) as well as presence of CMO order set at time of death (p < 0.001). Compared with medical ICUs, odds of palliative care consultation were highest in the cardiothoracic ICU and trauma ICU. Odds of CMO order set in place at time of death were highest in the neurology/neurosurgical ICU. Conclusion: Utilization of specialty palliative care consultations and CMO order sets varies across types of ICUs. Examining this variability within institutions may provide an opportunity to improve end-of-life care for patients with chronic, life-limiting illnesses who die in the ICU.
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Affiliation(s)
- Joshua D Lee
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Ann L Jennerich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Lois Downey
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Nita Khandelwal
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA
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10
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Gonçalves-Teixeira P, Barbosa AR, Silva M, Almeida JG, Ponte M, Dias A, Fontes-Carvalho R, Braga P, Caeiro D. Intensive cardiovascular care units after half a century: Insights from the Portuguese experience. Rev Port Cardiol 2020; 39:411-413. [PMID: 32684416 DOI: 10.1016/j.repc.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pedro Gonçalves-Teixeira
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ana Raquel Barbosa
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - Marisa Silva
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | | | - Marta Ponte
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - Adelaide Dias
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Braga
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
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11
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Gonçalves-Teixeira P, Barbosa AR, Silva M, Almeida JG, Ponte M, Dias A, Fontes-Carvalho R, Braga P, Caeiro D. Intensive cardiovascular care units after half a century: Insights from the Portuguese experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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