Palliative status and short-term outcomes in very elderly patients with heart failure
R Esser, C Pepin, M Larbaneix, A Mondragon, M Esteban, C Farges, N Pages, S Nisse Durgeat, O Maurou, M HarbounAbstract
Background
In very old patients with advanced heart failure (HF), identifying those who may benefit from early palliative care integration remains challenging. Despite high short-term mortality, criteria guiding orientation toward specialised inpatient palliative care pathways (LISP) are not standardised and rely largely on clinical judgement. Determinants and prognostic implications of LISP orientation in cardiogeriatric HF populations remain insufficiently described.
Methods
We conducted a retrospective observational study including consecutive patients aged ≥75 years hospitalised for acute HF in a cardiogeriatric unit. Clinical, geriatric, biological, and echocardiographic data were collected at discharge. Orientation toward a specialised inpatient palliative care pathway (LISP) was recorded. All-cause mortality, HF-related mortality, and HF rehospitalisation at 3 and 6 months were assessed. Logistic regression analyses identified factors associated with LISP orientation.
Results
Among 369 patients (median age >85 years), 47 (12.7%) were oriented toward a LISP pathway. LISP orientation was strongly associated with higher all-cause mortality at 3 months (OR 5.19, 95% CI 2.72–9.91) and 6 months (OR 6.57, 95% CI 3.37–12.82), as well as higher HF-related mortality at 3 months (OR 2.76, 95% CI 1.09–6.98) and 6 months (OR 4.45, 95% CI 1.98–10.02). In contrast, LISP orientation was not associated with HF rehospitalisation at 3 or 6 months. LISP status was independently associated with severe cognitive impairment, functional dependency, depressive symptoms, and higher NT-proBNP levels at discharge, reflecting advanced multidimensional vulnerability. These geriatric features characterised patients oriented toward palliative care rather than acting as independent predictors of mortality.
Conclusions
In very old patients with HF, specialised palliative care orientation identifies a subgroup with extreme vulnerability and very high short-term mortality, without increased rehospitalisation. In the absence of standardised criteria, cardiogeriatric clinical judgement appears effective in identifying patients who may benefit from palliative-oriented pathways, which may help avoid non-beneficial hospitalisations by supporting proportionate, goal-oriented care in advanced-age HF populations.