Researchers: Freda DeKeyser Ganz^{1, 2}, Israel Gotsman^{1, 3}

Background: Heart Failure (HF) is a global epidemic, with significant morbidity and mortality. HF patients suffer from symptoms similar to other life-threatening illnesses. Palliative care (PC) has been recommended as a treatment option for HF, however its provision is low. A significant barrier is the identification of patients who can benefit from PC. One method is the Gold Standards Framework (GSF).

Objectives: To describe community-based PC services and to determine if the GSF can identify HF patients in need of PC.

Method: A convenience sample of community dwelling patients with NYHA level III or IV were surveyed. Demographic and symptom burden data were collected by patient questionnaires. Medical history and use of medical services were obtained from medical records. Medical caregivers were asked to complete the GSF Guidance report, determining the need for PC services.

Findings: A total of 252 HF patients were recruited, with a mean age of 76.9 years (SD= 10.9). The majority (70%) of patients did not receive treatment for pain, anxiety, sleep disorders or depression. Eight patients spoke with a psychologist or psychiatrist (3.2%), one participant had a written advanced directive and five had recorded end-of-life discussions. Only 22 patients (8.7%) did not meet any of the GSF criteria, with 68% (n=162) meeting four or more criteria, and 51 participants receiving PC. The sensitivity and specificity of the GSF was 21.21% and 90.91%, respectively.

Conclusions: The vast majority of participants in this study were in need of PC services but did not receive them. The GSF framework was not able to accurately identify HF patients in need of PC services.

Recommendations: Increased efforts should be made to identify and treat HF patients in need of PC. Other triggers or methods should be investigated to identify HF patients in need.

Research end date: 01/2020