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Heart failure and palliative care in the emergency department
  1. Matthew Lipinski1,
  2. Debra Eagles1,2,
  3. Lisa M Fischer1,
  4. Lisa Mielniczuk3,
  5. Ian G Stiell1,2
  1. 1Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  3. 3University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Matthew Lipinski, Department of Emergency Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; mlipinski{at}


Objectives Heart failure is a common ED presentation that is underserved by palliative care services and is associated with significant morbidity and mortality. We sought to evaluate 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.

Methods We conducted a health records review of 500 patients with heart failure who presented to two Canadian academic hospital EDs from January to August 2013.

Results Patients were of mean age 80.7 years, women (53.2%) and had significant comorbidities. Only 41% of all deceased patients at 1 year had any palliative care involvement. Of those with palliative care, 44 (76%) patients had less than 2 weeks of palliative care involvement prior to death. Compared with those with no palliative care, the 79 (15.8%) patients with palliative care involvement had a higher 1-year mortality rate (70.9% vs 18.8%) and more hospital admissions/year (1.4 vs 0.85) for heart failure.

Conclusions We found that few patients with heart failure had palliative care services. Additionally, the majority of those who have palliative care involvement do not meet current recommendations for early palliative care involvement in heart failure. This study suggests that the ED may be an appropriate setting to identify and refer high-risk patients with heart failure who could benefit from earlier palliative care involvement.

  • heart failure
  • emergency department
  • assessment

Statistics from


  • Contributors ML conceived the idea, collected the data and prepared the manuscript. DE provided considerable assistance in study design and statistics, and revised the manuscript. LMF provided assistance in study design and revised the manuscript. LM provided expert content opinion, provided the preliminary UOHI palliative care referral pilot data and revised the manuscript. IGS provided considerable statistical assistance, input on study design and revision of the manuscript. ML had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ottawa Health Sciences Network Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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