title: Identifying acute coronary syndrome patients approaching end-of-life.
abstract: BACKGROUND
  Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL.
  
  
  RESULTS
  172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88).
  
  
  CONCLUSIONS
  This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fenning
authors.forename: Rebecca
authors.initials: R
authors.lastname: Woolcock
authors.forename: Kristin
authors.initials: K
authors.lastname: Haga
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.forename: Keith A
authors.initials: KA
authors.lastname: Fox
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
authors.forename: Martin A
authors.initials: MA
authors.lastname: Denvir
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013727:Terminal Care; D019452:Terminally Ill