PMID- 21554021
OWN - NLM
STAT- MEDLINE
DCOM- 20111108
LR  - 20110624
IS  - 1557-7740 (Electronic)
IS  - 1557-7740 (Linking)
VI  - 14
IP  - 7
DP  - 2011 Jul
TI  - Outpatient palliative care for chronic heart failure: a case series.
PG  - 815-21
LID - 10.1089/jpm.2010.0508 [doi]
AB  - BACKGROUND/OBJECTIVES: Although the palliative care needs of outpatients with 
      chronic heart failure (HF) are numerous, there is limited published experience in 
      providing outpatient HF palliative care. This article describes the patients seen 
      and the issues addressed in an outpatient palliative care program for patients 
      with HF. METHODS: Case series involving a retrospective medical record review 
      using descriptive quantitative and qualitative analysis. RESULTS: Over a 3 (1/2) year 
      time period, 50 patients were seen, resulting in 228 total visits. Fifty percent 
      of patients were seen only once. Fifty-eight percent of patients had New York 
      Heart Association (NYHA) Class III-IV HF. Within a year of the initial palliative 
      care visit, 14% of patients died. Depression, anxiety, pain, fatigue, 
      breathlessness, and sleep disturbance were common symptoms addressed during 
      visits. Advance care planning topics were discussed with 48% of patients; hospice 
      and resuscitation status were each discussed with 16% of patients. Fears or 
      concerns about the future arose in 34% of patients. Care coordination was 
      commonly addressed with patients' other health care providers (58%). The most 
      common referrals were to social work (26%) and rehabilitation/physical therapy 
      (20%). CONCLUSIONS: Several findings reflect how outpatient HF palliative care 
      differs from that of inpatient hospital-based palliative care. Many of the issues 
      addressed, including care coordination, advance care planning, and psychosocial 
      issues, imply that palliative HF care is complementary to standard HF care at all 
      stages of the disease process and that future programs should consider dedicating 
      a nurse and/or social worker. Research is needed to test how such a care model 
      affects patient-centered outcomes, utilization, and cost.
FAU - Bekelman, David B
AU  - Bekelman DB
AD  - Department of Veterans Affairs Medical Center , Denver, CO 80220, USA. 
      david.bekelman@va.gov
FAU - Nowels, Carolyn T
AU  - Nowels CT
FAU - Allen, Larry A
AU  - Allen LA
FAU - Shakar, Simon
AU  - Shakar S
FAU - Kutner, Jean S
AU  - Kutner JS
FAU - Matlock, Daniel D
AU  - Matlock DD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110509
PL  - United States
TA  - J Palliat Med
JT  - Journal of palliative medicine
JID - 9808462
SB  - IM
MH  - Adult
MH  - *Ambulatory Care
MH  - Colorado
MH  - Female
MH  - *Heart Failure/therapy
MH  - Humans
MH  - Male
MH  - Medical Audit
MH  - Middle Aged
MH  - Palliative Care/*methods
MH  - Retrospective Studies
EDAT- 2011/05/11 06:00
MHDA- 2011/11/09 06:00
CRDT- 2011/05/11 06:00
PHST- 2011/05/11 06:00 [entrez]
PHST- 2011/05/11 06:00 [pubmed]
PHST- 2011/11/09 06:00 [medline]
AID - 10.1089/jpm.2010.0508 [doi]
PST - ppublish
SO  - J Palliat Med. 2011 Jul;14(7):815-21. doi: 10.1089/jpm.2010.0508. Epub 2011 May 
      9.