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  1. Mary Dawood, Associate Editor
  1. Correspondence to Mary Dawood, Emergency Department, Imperial College NHS Trust, London, UK; Mary.dawood{at}

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Palliative care in the ED

Heart failure, a common presentation in the ED is associated with significant morbidity and mortality. This is a patient group that have a poor quality of life and would benefit from early palliative care but it’s not often considered in the ED for various reasons. So, it was interesting to read a study by Lewinski and colleagues from Canada, they sought to evaluate the use of palliative care services in patients with heart failure presenting to the ED. The primary outcome studied was palliative care involvement. Secondary outcomes of the study were: (1) 1 year mortality, (2) ED visits, (3) hospital admissions, and (4) Heart Failure Clinic involvement. They conducted a health records review of 500 heart failure patients who presented to two Canadian academic hospital EDs. Unsurprisingly, they found that few heart failure patients had palliative care services. Additionally, the majority of those that had palliative care involvement did not meet current recommendations for early palliative care involvement in heart failure. The authors suggest that the Emergency Department may be an appropriate setting to identify and refer high risk heart failure patients who could benefit from earlier palliative care. Although a small study of only two hospitals, this thought provoking paper is well worth …

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