267775 Care gaps and unaddressed palliative needs as sources of distress in advanced heart failure

Monday, October 29, 2012

Dio Kavalieratos, BPhil , Department of Health Policy and Management, University of North Carolina School of Public Health, Chapel Hill, NC
Amy Abernethy, MD , Division of Medical Oncology, Duke University Medical Center, Durham, NC
Background: Heart failure (HF) affects approximately 5.8 million Americans. Characterized by significant disease management needs and high healthcare utilization, HF presents a prime target for care coordination, such as that of community-based palliative care (PC). Quality monitoring is vital to establishing general care effectiveness and uptake evidence-based practices, which are poorly understood in PC. The Carolinas Consortium maintains the US's largest multi-site community-based PC quality monitoring database; here, we highlight its role in HF. Methods: The Carolinas Consortium established a standardized, point-of-care data collection system that accumulates clinician, patient, and proxy reported data from community-based PC sites. We analyzed initial PC visit data for all HF patients. Variables assessed include demographics, symptoms, quality-of-life, and functioning. Functional status was measured using the Palliative Performance Scale (PPS); QOL and symptoms were scored on 4-point scales. Results: Of 5,959 patients, 13.9% had a diagnosis of HF. Fifty-nine percent were female, 91% Caucasian, and median age was 85 years [range: 52-101]. At referral, 60% of patients had significant functional limitations (PPS <50%), requiring assistance with self-care. Forty-one percent reported “poor” QOL. Symptoms most frequently reported as “moderate” or “severe” were: fatigue (53%), anorexia (28%), and dyspnea (25%). Conclusions: HF patients experience functional impairment and symptom burden leading to poor QOL. PC may have a role in improving advanced HF care and patient QOL; however, patients are referred for PC late in the disease trajectory. This type of information is critical for service and workforce planning among the growing number of community-based PC programs.

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Clinical medicine applied in public health
Public health or related research

Learning Objectives:
1. Discuss the care gaps experienced by heart failure patients and the link to patient-centered outcomes 2. Identify mechanisms for improved heart failure care by way of palliative medicine 3. Describe the development of a multi-site palliative care quality monitoring database and its utility in identifying gaps in heart failure care.

Keywords: Heart Disease, End-of-Life Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD candidate in health policy, with experience conducting mixed-methods health services research. For over six years, I have been involved in palliative and hospice care research, specifically regarding patient-centered outcomes, access to care, quality of services, and disease-based disparities in utilization.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.