SP11.6 End of Life Care and Advance Care Planning for Outpatients with Inoperable Abdominal Aortic Aneurysms – A Retrospective Cohort Study

Abstract

Abstract Introduction A proportion of patients with aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, there exist no studies on the palliative care (PC) and advance care planning (ACP) they receive following discharge from the clinic. Methods We conducted a multicentre cohort study of 220 conservatively managed AA patients referred to centres in Leeds and the Maastricht for intervention between 2017 and 2021, from a combined total of 1506 patients - a non-intervention rate of 15%. Demographic details, mortality, cause of death, ACP and PC outcomes were analysed to examine predictors of PC referral and consultation efficacy. Results There was a 3-year mortality rate of 60%. Rupture was the reported cause of death in 17% of the decedents. Only 9% of all patients received PC referrals - a median of 3.5 days before death. Patients over 80 were more likely to have PCCs. Almost half of the decedents were readmitted to hospital before death and 37% died in hospital. Only 5% of patients had a documented preferred place of death. Patients with PCCs were more likely to have preferred place of death and care priorities documented. Conclusion Only a small proportion of conservatively treated patients with AAs had ACP, far below 2019 NICE end-of-life care guidance. It is also far below the level offered to oncology patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention are offered end-of-life care and ACP.