PMID- 34722076
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240403
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 9
DP  - 2021 Sep
TI  - Palliative Care in Heart Failure: Challenging Prognostication.
PG  - e18301
LID - 10.7759/cureus.18301 [doi]
LID - e18301
AB  - Heart failure (HF) is a chronic progressive disease with high morbimortality and 
      poor quality of life (QoL). Palliative care significantly improves clinical 
      outcomes but few patients receive it, in part due to challenging decisions about 
      prognosis. This retrospective study, included all patients consecutively 
      discharged from an Acute Heart Failure Unit over a period of one year, aiming to 
      assess the accuracy of the Meta-Analysis Global Group in Chronic Heart Failure 
      (MAGGIC) score in predicting mortality. Additionally, predictors of death at one 
      and three years were explored using a multivariate regression model. The MAGGIC 
      score was useful in predicting mortality, without significant difference between 
      mortality observed at three-years follow-up compared with a mortality given by 
      the score (p=0.115). Selected variables were statistically compared showing that 
      poor functional status, high New York Heart Association (NYHA) at discharge, 
      psychopharmacs use, and high creatininemia were associated with higher mortality 
      (p<0.05). The multivariate regression model identified three predictors of 
      one-year mortality: psychopharmacs baseline use (OR=4.110; p=0.014), 
      angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) 
      medication at discharge (OR=0.297; p=0.033), and higher admission's creatinine 
      (OR=2.473; p=0.028). For three-year mortality outcome, two variables were strong 
      independent predictors: psychopharmacs (OR=3.330; p=0.022) and medication with 
      ACEI/ARB at discharge (OR=0.285; p=0.018). Models' adjustment was assessed 
      through the receiver operating characteristic (ROC) curve. The best model was the 
      one-year mortality (area under the curve, AUC 81%), corresponding to a good 
      discrimination power. Despite prognostication, when setting goals of care an 
      individualised patient-centred approach is imperative, based on the patient's 
      objectives and needs. Risk factors related to poorer outcomes should be 
      considered, in particular, higher NYHA at discharge which also represents symptom 
      burden. Hospitalisation is an opportunity to optimize global care for heart 
      failure patients including palliative care.
CI  - Copyright (c) 2021, Egidio de Sousa et al.
FAU - Egidio de Sousa, Ines
AU  - Egidio de Sousa I
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Pedroso, Ana
AU  - Pedroso A
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Chambino, Beatriz
AU  - Chambino B
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Roldao, Marta
AU  - Roldao M
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Pinto, Fausto
AU  - Pinto F
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Guerreiro, Renato
AU  - Guerreiro R
AD  - Internal Medicine Department, Hospital Sao Francisco Xavier, Lisbon, PRT.
FAU - Araujo, Ines
AU  - Araujo I
AD  - Heart Failure Clinic, Department of Internal Medicine, Hospital Sao Francisco 
      Xavier, Lisbon, PRT.
FAU - Henriques, Celia
AU  - Henriques C
AD  - Heart Failure Clinic, Department of Internal Medicine, Hospital Sao Francisco 
      Xavier, Lisbon, PRT.
FAU - Fonseca, Candida
AU  - Fonseca C
AD  - Heart Failure Clinic, Department of Internal Medicine, Hospital Sao Francisco 
      Xavier, Lisbon, PRT.
LA  - eng
PT  - Journal Article
DEP - 20210926
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8548045
OTO - NOTNLM
OT  - heart failure
OT  - maggic score
OT  - mortality
OT  - palliative care
OT  - prognostication
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/11/02 06:00
MHDA- 2021/11/02 06:01
PMCR- 2021/09/26
CRDT- 2021/11/01 09:21
PHST- 2021/09/26 00:00 [accepted]
PHST- 2021/11/01 09:21 [entrez]
PHST- 2021/11/02 06:00 [pubmed]
PHST- 2021/11/02 06:01 [medline]
PHST- 2021/09/26 00:00 [pmc-release]
AID - 10.7759/cureus.18301 [doi]
PST - epublish
SO  - Cureus. 2021 Sep 26;13(9):e18301. doi: 10.7759/cureus.18301. eCollection 2021 
      Sep.