title: Predicting discharge of palliative care inpatients by measuring their heart rate variability.
abstract: OBJECTIVE
  Home discharge after hospital admission to an inpatient palliative care unit (PCU) is a major challenge. Dysfunction of the autonomic nervous system is commonly observed in patients with advanced cancer in this setting. The aim of this prospective observational study was to determine whether the measurement of heart rate variability (HRV) by assessing parameters of the autonomic nervous system on a 24-h-ECG at the time of admission to the PCU was correlated with the likelihood of discharge.
  
  
  METHODS
  Sixty hospitalized patients with advanced cancer of distinct origin, admitted to a PCU, were enrolled consecutively. The Karnofsky performance status scale (KPS) and the palliative performance scale (PPS) were obtained. HRV was measured over one day (20-24 hours) using a portable five-point ECG. The aim of the study was to compare HRV measurements in patients who could be discharged and those who died. The association of these variables with home discharge or death at the PCU was calculated.
  
  
  RESULTS
  Discharge was achieved in 45% of patients while 55% of patients died. Median KPS and median PPS on admission were significantly higher in discharged patients than in those who died (P=0.001). Patients who were discharged tended to have a higher HRV, although the difference was not significant.
  
  
  CONCLUSIONS
  KPS and PPS were significant predictors of the likelihood of discharge while HRV did not predict discharge.
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Email: eva.masel@meduniwien.ac.at.
authors.forename: Eva Katharina
authors.initials: EK
authors.lastname: Masel
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Huber
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schur
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Kierner
authors.affiliation: Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Romina
authors.initials: R
authors.lastname: Nemecek
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Watzke
keywords: Autonomic nervous system; cancer care units; discharge planning; palliative care; terminal care