Identifying acute coronary syndrome patients approaching end-of-life.

<h4>Background</h4>Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coro...

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Autores principales:	Stephen Fenning, Rebecca Woolcock, Kristin Haga, Javaid Iqbal, Keith A Fox, Scott A Murray, Martin A Denvir
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/575fd1b6f1414f1a9cc450526c2f91e7
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spelling	oai:doaj.org-article:575fd1b6f1414f1a9cc450526c2f91e72021-11-18T07:21:43ZIdentifying acute coronary syndrome patients approaching end-of-life.1932-620310.1371/journal.pone.0035536https://doaj.org/article/575fd1b6f1414f1a9cc450526c2f91e72012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22530044/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL.<h4>Methods and findings</h4>172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88).<h4>Conclusions</h4>This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.Stephen FenningRebecca WoolcockKristin HagaJavaid IqbalKeith A FoxScott A MurrayMartin A DenvirPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 4, p e35536 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stephen Fenning Rebecca Woolcock Kristin Haga Javaid Iqbal Keith A Fox Scott A Murray Martin A Denvir Identifying acute coronary syndrome patients approaching end-of-life.
description	<h4>Background</h4>Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL.<h4>Methods and findings</h4>172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88).<h4>Conclusions</h4>This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.
format	article
author	Stephen Fenning Rebecca Woolcock Kristin Haga Javaid Iqbal Keith A Fox Scott A Murray Martin A Denvir
author_facet	Stephen Fenning Rebecca Woolcock Kristin Haga Javaid Iqbal Keith A Fox Scott A Murray Martin A Denvir
author_sort	Stephen Fenning
title	Identifying acute coronary syndrome patients approaching end-of-life.
title_short	Identifying acute coronary syndrome patients approaching end-of-life.
title_full	Identifying acute coronary syndrome patients approaching end-of-life.
title_fullStr	Identifying acute coronary syndrome patients approaching end-of-life.
title_full_unstemmed	Identifying acute coronary syndrome patients approaching end-of-life.
title_sort	identifying acute coronary syndrome patients approaching end-of-life.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/575fd1b6f1414f1a9cc450526c2f91e7
work_keys_str_mv	AT stephenfenning identifyingacutecoronarysyndromepatientsapproachingendoflife AT rebeccawoolcock identifyingacutecoronarysyndromepatientsapproachingendoflife AT kristinhaga identifyingacutecoronarysyndromepatientsapproachingendoflife AT javaidiqbal identifyingacutecoronarysyndromepatientsapproachingendoflife AT keithafox identifyingacutecoronarysyndromepatientsapproachingendoflife AT scottamurray identifyingacutecoronarysyndromepatientsapproachingendoflife AT martinadenvir identifyingacutecoronarysyndromepatientsapproachingendoflife
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Identifying acute coronary syndrome patients approaching end-of-life.

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