Palliative care interventions have been recommended for patients suffering from end-stage heart failure (HF), however to date, their impact remains uncertain. At our center, we implemented the Heartfull program - a collaborative model of care that integrates specialist cardiology and home-based interdisciplinary teams to support patients and their primary care providers. The program aimed to provide relief of refractory symptoms and help patients achieve their goal of dying outside of an acute care setting. We evaluated place of death for patients enrolled in the Heartfull program and compared their experience to a pre-implementation group of advanced HF patients identified via an environmental scan. We hypothesized that our program has shifted the place of death for advanced HF patients. HF patients followed at Mount Sinai Hospital in Toronto, Canada, who were NYHA class III/IV (despite optimal medical and device therapy), ineligible for transplant and considered appropriate for palliative care consultation, were referred by their cardiologist to Heartfull. Thirty patients were enrolled in a prospective longitudinal cohort study that examined their care experiences up until death (n=22). Patients who died were followed for 115 +/- 109 days. Place of death included the home (n=10), palliative care unit (PCU) (n=6) or acute care hospital (n=6) - with 73% of these deaths occurring outside acute care and 27% in hospital. A retrospective chart audit of patients seen in the Heart Function Clinic in the year prior to Heartfull implementation was performed to identify patients with advanced HF for whom palliative care may have been appropriate. In up to 24 months of follow up, 19 deaths were identified. In this environmental scan, place of death included the home (n=2), PCU (n=1), acute care hospital (n=12) or unknown (n=4) – with 63% deaths occurring in hospital. Compared to the pre-implementation cohort, the patients enrolled in Heartfull were significantly more likely (p=0.041) to die at home or in a PCU (Figure 1), spend more days per month out of hospital, and have fewer ED visits (Table 1). As expected, patients enrolled in Heartfull had a high mortality and received palliative care for approximately 4 months before dying. We demonstrated that Heartfull made it feasible to support death outside the acute care hospital. Our results may represent a significant shift in care of end-stage HF patients compared to the period preceding Heartfull implementation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)