title: Palliative care consultations for heart failure patients: how many, when, and why?
abstract: OBJECTIVE
  In preparation for development of a palliative care intervention for patients with heart failure (HF) and their caregivers, we aimed to characterize the HF population receiving palliative care consultations (PCCs).
  
  
  RESULTS
  Reviewing charts from January 2006 to April 2011, we analyzed HF patient data including demographic and clinical characteristics, Seattle Heart Failure scores, and PCCs. Using Atlas qualitative software, we conducted a content analysis of PCC notes to characterize palliative care assessment and treatment recommendations. There were 132 HF patients with PCCs, of which 37% were New York Heart Association functional class III and 50% functional class IV. Retrospectively computed Seattle Heart Failure scores predicted 1-year mortality of 29% [interquartile range (IQR) 19-45] and median life expectancy of 2.8 years [IQR 1.6-4.2] years. Of the 132 HF patients, 115 (87%) had died by the time of the audit. In that cohort the actual median time from PCC to death was 21 [IQR 3-125] days. Reasons documented for PCCs included goals of care (80%), decision making (24%), hospice referral/discussion (24%), and symptom management (8%).
  
  
  CONCLUSIONS
  Despite recommendations, PCCs are not being initiated until the last month of life. Earlier referral for PCC may allow for integration of a broader array of palliative care services.
authors.affiliation: Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. marie.bakitas@hitchcock.org
authors.forename: Marie
authors.initials: M
authors.lastname: Bakitas
authors.forename: Meredith
authors.initials: M
authors.lastname: Macmartin
authors.forename: Kenneth
authors.initials: K
authors.lastname: Trzepkowski
authors.forename: Alina
authors.initials: A
authors.lastname: Robert
authors.forename: Lisa
authors.initials: L
authors.lastname: Jackson
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: James N
authors.initials: JN
authors.lastname: Dionne-Odom
authors.forename: Alan
authors.initials: A
authors.lastname: Kono
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods* / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors