Prevalence of Sudden Death in Palliative Care: Data from the Australian Palliative Care Outcomes Collaborative (PCOC)

• Published in: Journal of pain and symptom management
• Main Authors: Ekström, Magnus, MD, PhD, Vergo, Maxwell T., MD, Ahmadi, Zainab, MD, Currow, David C., B Med, MPH, PhD, FRACP, FAHMS
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Anesthesia & Perioperative Care; Pain Medicine; lung cancer; fatigue; Sudden death; performance status; breathlessness; palliative care
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2016.02.015

Abstract Context Advanced, life-limiting illnesses are likely to have a predictable functional decline through a terminal phase to death, but some patients may also die suddenly. To date, empirical evidence characterizing “sudden death” in hospice/palliative care is lacking. Objectives To determine prevalence and clinico-demographic predictors of sudden death in hospice/palliative care. Methods Longitudinal consecutive cohort study of prospectively collected national data in 104 specialist palliative care services from the Australian Palliative Care Outcomes Collaboration. Patients who died between1 July 2013 and 30 June 2014 with ≥1 measurement of Australian-modified Karnofsky Performance Status (AKPS) in the last 30 days of life were included. ‘Sudden death’ was defined as a lowest AKPS ≥50 in the last seven days of life and excluded anyone with ‘terminal phase’ as their last phase prior to death. Predictors were defined using logistic regression. Results In total, 13,966 patients were included; mean age 73.6 (SD 13.6) years, 46% women, 77% had cancer. During the seven days before death, there were 20,992 AKPS measurements; median 1 (interquartile range [IQR], 1 to 2) per patient. Four percent of deaths (1/25) were sudden, predicted independently by having lung cancer (OR 2.64), cardiovascular disease (OR 1.94), other cancers (OR 1.63), being male (OR 1.23), younger, worse fatigue and worse breathlessness. Sudden death was associated with higher rates of death at home; OR 3.2 (95% CI, 2.9 to 3.6). Conclusion This study quantifies rates of sudden death in hospice/palliative care and has implications for conversations about prognosis between clinicians, patients and their families.