Abstract
BackgroundAcute 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.Methods and Findings172 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).ConclusionsThis 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.
Highlights
The importance of well-coordinated supportive care at end of life (EoL) is increasingly recognised as more people survive into old age with multiple chronic long term conditions
Gold Standards Framework (GSF) or Global Registry of Acute Coronary Events (GRACE) could be used in the hospital setting to help identify these patients
Despite calls for better EoL care there continues to be a lack of research examining ways in which it could be integrated into normal clinical care pathways especially in the acute hospital setting
Summary
The importance of well-coordinated supportive care at end of life (EoL) is increasingly recognised as more people survive into old age with multiple chronic long term conditions. EoL care is often poorly co-ordinated, with inadequate communication and cohesion between primary care, cardiologists and palliative care specialists [8,9]. These problems have been attributed to clinicians being in a state of ‘‘prognostic paralysis’’, uncertain about the illness trajectory of heart disease and uncertain about when to initiate EoL care planning [10]. 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
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