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Heart failure and palliative care in the emergency department
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  • Published on: 20 February 2019
    Emergency Department Setting: an opportunity to detect the patient with heart failure who may benefit from palliative care.
    • MARTA MERLO, Emergency Department Hospital Universitario de Getafe (Madrid-Spain) / Universidad Europea (Madrid-Spain)
    • Other Contributors:
      • Rodolfo Romero, Emergency department
      • Francisco Javier Martin-Sánchez, Emergency Department

    Dear Editor,
    We have read the study published by Lipinski et al.(1) in which the authors observed that only a little percentage of patients with heart failure (HF) were monitored by a specific palliative care (PC) team. Also, this usually happened in the last two weeks of life. This suggests the need to identify earlier high-risk patients who can benefit from monitoring by a palliative care team (1).
    In relation to this study, we would like to share our experience in a Spanish Emergency Department (ED). Our study included 143 patients with acute HF (AHF), mean age 82.5 (range 65-99) years old, of whom 69 (48.2%) were women. None of these patients were being monitored by a PC team before their admission in ED and only 8 (5.6%) were transferred to PC after the index visit. Out of 8 patients included in CP, 3 (37.5%) died within 30 days after visiting ED. Although our cohort had a lower 1-year mortality than the Canadian study (18.2% vs 27.0%), our findings confirm that older patients with AHF are not frequently followed-up by a PC team, although HF is known to be a disease with a progressive course which is associated with a significant morbidity and mortality, and a high consumption of socio-health resources (2). This may be due to the lack of awareness, among health professionals, that HF is a chronic disease with a poor 5-year prognosis, and the need of palliative care for older patients with HF in an earlier phase than the terminal care (3).
    In conclusi...

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    Conflict of Interest:
    None declared.