The Landscape of Cardiac Palliative Care Practices in the United States (S806)

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1.Describe clinical characteristics of U.S. cardiac palliative care programs.2.Differentiate between U.S. cardiac palliative care programs challenges and successes. Patients with advanced cardiac disease (CD), and their caregivers, may benefit from early palliative care (PC) services. There is limited information on the number and nature of U.S. cardiac PC programs. To describe operational and clinical characteristics of U.S. cardiac PC programs. We developed, pilot tested, and disseminated an Internet survey to a convenience snowball sample of U.S. cardiac PC programs. The survey included closed- and open-ended questions on practice type, CD, service utilization, staffing, practice characteristics, referrals, funding sources, services, and challenges. Seven (70%) cardiac PC programs completed the survey. Most programs identified as comprehensive (in-, out-, home services), outpatient (12.5%), inpatient (25%), or combined (25%). Programs varied in duration of existence, from one month-12 years. All programs served HF patients, while others serve heart transplant (75%), COPD (75%), pulmonary arterial hypertension (62.5%), and interstitial lung disease (62.5%). Most outpatient programs (71.4%) saw less than 50 new patients annually, whereas one practice served 400. Most common referral reasons were discussion of goals, management of emotional symptoms, and preparedness planning for ventricular assist devices. The most commonly managed symptoms were fatigue, dyspnea, depression, and anxiety. PC co-management (57.1%) and consult only PC (57.1%) were the most common practice models. All of the cardiac PC practices had expanded since opening. Qualitative follow up interviews are planned to provide a deeper program understanding. Though cardiac PC programs are in their infancy, there has been significant growth and need for expansion. Understanding current cardiac palliative care services, potential funding sources, and future needs is a high clinical/research priority.