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Performing sit down medicine in a stand-up place: is it time for palliative care in the emergency department?
  1. Eric D Adler,
  2. Quan M Bui
  1. Department of Medicine, Division of Cardiology, University of California, San Diego, California, USA
  1. Correspondence to Dr Eric D Adler, Division of Cardiology, Department of Medicine, University of California, San Diego, CA 92037, USA; eradler{at}ucsd.edu

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Despite progress, the heart failure (HF) epidemic continues unabated worldwide.1 HF remains among the most common reasons for hospitalisations with the majority of these admissions occurring through the ED. Patients with advanced disease make up a disproportionately large share of hospitalised patients with HF and are particularly symptomatic with arguably the worst quality of life among chronically ill patients; hence, it is not a surprise that they end up in the ED frequently.1

It seems evident that palliative care, a specialty whose focus is symptom management, would provide significant benefit to those with advanced HF. Evidence suggests that palliative care specialists can improve quality of life and resource use among patients with HF. More recently, the Palliative Care in Heart Failure (PAL-HF) trial demonstrated improvements in physical, psychosocial and quality-of-life domains through a systemic approach to outpatient palliative care, involving a single nurse practitioner and palliative care specialist, in a high-risk HF population.2 Hence, it is no surprise that guidelines recommend palliative care for patients with advanced HF. Most studies suggest that it is vastly underused in this patient population.3

The intriguing manuscript by Lipinski et al further supports these previous studies. In this retrospective study of 500 patients with HF who presented to two different Canadian EDs, only 40% of patients who died within a year of ED presentation had palliative care …

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