Evidence map›Paper›PMID 35863850›Full record

ArticleJournal of the American College of Cardiology2022

Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care.

Yuchieh Kathryn Chang, Larry A Allen, John A McClung, Martin A Denvir, Jennifer Philip, Masanori Mori, Pedro Perez-Cruz, Shao-Yi Cheng, Anna Collins, David Hui

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In one paragraph

Article in Journal of the American College of Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Yuchieh Kathryn ChangDepartment of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Larry A AllenUniversity of Colorado School of Medicine, Aurora, Colorado, USA.
John A McClungDepartment of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
Martin A DenvirEdinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Jennifer PhilipDepartment of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia.
Masanori MoriPalliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Pedro Perez-CruzPrograma Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Shao-Yi ChengDepartment of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
Anna CollinsDepartment of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia.
David HuiDepartment of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address: dhui@mdanderson.org.

Funding

Efficacy and Safety of Rapid-Onset Opioids for Exertional Dyspnea in Cancer PatientsR01CA231471 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI HUI, DAVID · 2020 to 2024
$1.9M
Strategies for Persistent Agitated Delirium in Palliative CareR01CA225701 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI HUI, DAVID · 2019 to 2022
$1.9M
A Randomized Controlled Trial of Dexamethasone for Dyspnea in Cancer PatientsR01CA214960 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI HUI, DAVID · 2017 to 2020
$1.6M
NCI NIH HHS R01 CA214960NCI NIH HHS R01 CA225701NCI NIH HHS R01 CA231471
6 · The paper itself

Abstract

backgroundPatients with advanced heart failure have substantial supportive care needs. Specialist palliative care can be beneficial, but it is unclear who is most appropriate for referral and when patients should be referred.

objectivesWe conducted a Delphi study of international experts to identify consensus referral criteria for specialist palliative care for patients with advanced heart failure.

methodsClinicians from 5 continents with expertise in the integration of cardiology and palliative care were asked to rate 34 disease-based, 24 needs-based, and 9 time-based criteria over 3 rounds. Consensus was defined a priori as ≥70% agreement. A criterion was coded as major if the experts endorsed that meeting that criterion alone was adequate to justify a referral.

resultsThe response rate was 44 of 46 (96%), 41 of 46 (89%), and 43 of 46 (93%) in the first, second, and third rounds, respectively. Panelists reached consensus on 25 major criteria for specialist palliative care referral. The 25 major criteria were categorized under 6 topics, including "advanced/refractory heart failure, comorbidities, and complications" (eg, cardiac cachexia, cardiorenal syndrome) (n = 8), "advanced heart failure therapies" (eg, chronic inotropes, precardiac transplant) (n = 4), "hospital utilization" (eg, emergency room visits, hospitalization) (n = 2), "prognostic estimate" (n = 1), "symptom burden/distress" (eg, severe physical/emotional/spiritual distress) (n = 6), and "decision making/social support" (eg, goals-of-care discussions) (n = 4). The majority (68%) of major criteria had ≥90% agreement.

conclusionsInternational experts reached consensus on a large number of criteria for referral to specialist palliative care. With further validation, these criteria may be useful for standardizing palliative care access in the inpatient and/or outpatient settings.

Indexed as

Heart FailurePalliative CareConsensusHumansOutpatientsReferral and ConsultationDelphi techniqueheart failurepalliative carepatient selectionreferral and consultationsupportive care

Identifiers

PMID35863850
PMCPMC10615151

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.