Identifying acute coronary syndrome patients approaching end-of-life

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 h...

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Bibliographic Details
Published in:	PloS one Vol. 7; no. 4; p. e35536
Main Authors:	Fenning, Stephen, Woolcock, Rebecca, Haga, Kristin, Iqbal, Javaid, Fox, Keith A, Murray, Scott A, Denvir, Martin A
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 18-04-2012 Public Library of Science (PLoS)
Subjects:	Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute coronary syndromes Aged Aged, 80 and over Cancer Cardiac patients Cardiology Cardiovascular disease Chronic obstructive pulmonary disease Comorbidity Coronary vessels Criteria Embolisms Female Follow-Up Studies Health risk assessment Heart Hemodialysis Hospitals Humans Identification methods Kaplan-Meier Estimate Male Medical prognosis Medical research Medicine Middle Aged Mortality Palliative care Patients Primary care Prognosis Risk Factors ROC Curve Sensitivity and Specificity Terminal Care Terminally Ill Scotland Edinburgh Scotland United Kingdom > UK France
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Summary:	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. 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: MAD SAM KAF. Performed the experiments: SF RW KH. Analyzed the data: JI MAD KAF SAM. Wrote the paper: MAD KAF JI SAM.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0035536