Abstract
Heart failure (HF) is a chronic progressive disease with high morbimortality and poor quality of life (QoL). Palliative care significantly improves clinical outcomes but few patients receive it, in part due to challenging decisions about prognosis.This retrospective study, included all patients consecutively discharged from an Acute Heart Failure Unit over a period of one year, aiming to assess the accuracy of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in predicting mortality. Additionally, predictors of death at one and three years were explored using a multivariate regression model.The MAGGIC score was useful in predicting mortality, without significant difference between mortality observed at three-years follow-up compared with a mortality given by the score (p=0.115). Selected variables were statistically compared showing that poor functional status, high New York Heart Association (NYHA) at discharge, psychopharmacs use, and high creatininemia were associated with higher mortality (p<0.05).The multivariate regression model identified three predictors of one-year mortality: psychopharmacs baseline use (OR=4.110; p=0.014), angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) medication at discharge (OR=0.297; p=0.033), and higher admission's creatinine (OR=2.473; p=0.028). For three-year mortality outcome, two variables were strong independent predictors: psychopharmacs (OR=3.330; p=0.022) and medication with ACEI/ARB at discharge (OR=0.285; p=0.018). Models’ adjustment was assessed through the receiver operating characteristic (ROC) curve. The best model was the one-year mortality (area under the curve, AUC 81%), corresponding to a good discrimination power.Despite prognostication, when setting goals of care an individualised patient-centred approach is imperative, based on the patient’s objectives and needs. Risk factors related to poorer outcomes should be considered, in particular, higher NYHA at discharge which also represents symptom burden. Hospitalisation is an opportunity to optimize global care for heart failure patients including palliative care.
Highlights
Heart failure (HF) is a chronic and progressive disease and its prevalence in developed countries is around 12% in population aged 65 years and over with a trend to increase [1,2]
This study aims to assess the accuracy of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in predicting the mortality of hospitalised patients with acute HF, as well as identifying the impact of other variables on the mortality of these patients, in order to recognize high-risk HF patients for early referral to specialised palliative care
Despite consensus about the need for integration of palliative care in the management of HF, there are still no clear indications on how to implement the guidelines and early select patients who benefit from a specialised approach
Summary
Heart failure (HF) is a chronic and progressive disease and its prevalence in developed countries is around 12% in population aged 65 years and over with a trend to increase [1,2] It is an important healthcare problem, associated with high morbidity and mortality rates as well as poor quality of life (QoL) [3,4,5,6]. Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life It aims to improve the QoL of patients, their families, and their caregivers [8]. According to World Health Organization (WHO), European Society of Cardiology (ESC), and Portuguese Palliative Care Program, palliative care should be available and early integrated into the routine care for patients with HF alongside diseasemodifying treatment, and in the last days of life [9,10,11]
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