title: Prospective assessment of a palliative care tool to predict one-year mortality in patients with acute coronary syndrome.
abstract: BACKGROUND
  Identifying patients with acute coronary syndrome (ACS) who are approaching the end of life and who may not benefit from an aggressive interventional approach is important but clinically challenging. The Gold Standards Framework (GSF) prognostic guide was developed using multidimensional criteria to identify cancer patients who could benefit from end-of-life care. We assessed the utility of the GSF to predict one-year mortality in ACS patients.
  
  
  METHODS
  ACS patients admitted between May 2012 and July 2013 at the three participating cardiac centres in Europe were enrolled. Patients were assessed during admission using the GSF, the Global Registry of Acute Coronary Events (GRACE) score, the age, creatinine, ejection fraction (ACEF) score and the New York Percutaneous Coronary Intervention (NY-PCI) risk score. The pre-specified primary outcome was all-cause mortality at one year; secondary outcomes were cardiovascular death, non-cardiovascular mortality, re-hospitalisation for ACS and re-hospitalisation for non-ACS causes.
  
  
  RESULTS
  Six hundred and twenty-nine ACS patients were enrolled and one-year follow-up data was available for 626 patients. Fifty-two patients (8.3%) met GSF criteria for end-of-life care. These patients were older, predominantly female, had lower body mass index (BMI), and were less likely to receive angiography (75% vs 95%, p<0.001) and angioplasty (60% vs 77%, p=0.005) compared with patients who did not meet GSF criteria. Patients meeting GSF criteria had higher one-year all-cause mortality (42.3% vs 4.5%, p<0.001), cardiovascular mortality (15.4% vs 2.8%, p<0.001) and non-cardiovascular mortality (26.9% vs 1.7%; p<0.001). Multivariate analysis confirmed that meeting GSF criteria independently predicted all-cause mortality.
  
  
  CONCLUSIONS
  GSF is a multidimensional tool which may be used to identify ACS patients that are at high risk of death and may benefit from end-of-life care.
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: 2 South Yorkshire Cardiothoracic Centre, Northern General Hospital, UK.
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: 3 University of Edinburgh, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: Murray
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bertaina
authors.affiliation: 2 South Yorkshire Cardiothoracic Centre, Northern General Hospital, UK.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Parviz
authors.affiliation: 3 University of Edinburgh, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fenning
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.affiliation: 2 South Yorkshire Cardiothoracic Centre, Northern General Hospital, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Gunn
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Moiraghi
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Riccardini
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
authors.affiliation: 1 Città della Salute e della Scienza, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: 3 University of Edinburgh, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Denvir
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods*
keywords: Acute coronary syndrome; Gold Standards Framework; end of life; mortality; risk score