Risultati per: Approccio pre-rete e Cure Palliative di base

Circulation, Volume 150, Issue Suppl_1, Page A4142988-A4142988, November 12, 2024. Introduction:The latest expert consensus on catheter-based Left Atrial Appendage Occlusion (LAAO) suggests considering either transesophageal echocardiography (TEE) alone or the addition of Cardiac Computed Tomography Angiography (CCTA) for pre-procedural planning. However, evidence comparing the effectiveness of adding CCTA to regular TEE planning on procedural success is limited.Methods:We aimed to perform a systematic review and meta-analysis to determine the impact of adding CCTA to regular TEE for pre-procedural planning in patients undergoing LAAO. We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing TEE alone to TEE with the addition of CCTA. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.Results:Four studies were included in our meta-analysis, three of which were RCTs and one observational study, comprising a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher in the group with added CCTA (RR 1.10; 95% CI 1.01 – 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs alone confirmed these findings, with a slightly higher magnitude of effect in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15; 95% CI: 1.06 – 1.25; I2 = 0%).Conclusions:In this meta-analysis comparing TEE alone vs TEE with the addition of CCTA for preprocedural planning of LAAO, the addition of CCTA was associated with a higher procedural success rate, and this finding was confirmed in a subgroup analysis of randomized data.

Circulation, Volume 150, Issue Suppl_1, Page A4131100-A4131100, November 12, 2024. Background:Previous literature shows that metabolic surgery effectively decreases the risk of cardiovascular disease (CVD) events in patients with obesity. The use of metabolic surgery has, however, been limited in people with obesity and pre-existing CVD due to concerns of poor post-operative cardiovascular outcomes. This study aims to determine the effectiveness and safety of metabolic surgery in patients with pre-existing CVD.Methods:A search of electronic databases, PubMed, Cochrane Central and SCOPUS was conducted from their inception till May 2024. The study was conducted adhering to the PRISMA guidelines. Outcomes of interest were risk of all-cause mortality, major adverse cardiovascular events (MACE), risk of myocardial infarction (MI), and cerebrovascular events in patients with and without prior CVD undergoing bariatric surgery. Data was pooled as generic inverse variance using a random effects model, and presented as hazard ratios (HR) with their 95% confidence intervals (CI).Results:We included four studies in our analysis (n = 5,244). Our pooled analysis shows that metabolic surgery leads to significant reduction in risk of all-cause mortality (HR = 0.51, 95% CI: [0.42, 0.61]; p

Circulation, Volume 150, Issue Suppl_1, Page A4146754-A4146754, November 12, 2024. Background:Dobutamine stress echocardiography (DSE) is a frequently used tool in cardiovascular (CV) risk assessment of liver transplantation (LT) candidates. Its prognostic value compared to traditional cardiac risk stratification remains unclear.Research Question:How does the prognostic value of pre-transplant DSE in LT candidates compare to the revised cardiac risk index (RCRI)?Aim:Compare DSE’s prognostic value to RCRI in LT patients and analyze post-transplant CV outcomes.Methods:This single-center study included adult patients undergoing pre-transplant DSE as part of LT evaluation from 2008-2021. DSE were categorized as positive, negative, or inadequate. Primary outcomes were post-operative ischemic cardiac events and mortality, with secondary outcome of transplant delays from inadequate DSE. Mann-Whitney U and Fischer’s exact tests compared variables; logistic regression assessed RCRI and DSE for 30-day mortality and cardiac events.Results:Of 981 LT candidates, 644 (66%) had pre-transplant DSE with minimum 2-year follow-up. Average age was 57 ± 7 years, with 33% women. Four and eleven patients experienced cardiac events and mortality 1 (p-value 0.50), 0.51 for DSE (p-value 0.82), and 0.52 for RCRI >1 and DSE combined (p-value 0.80) in predicting 30-day mortality and cardiac events.Conclusion:Our study demonstrates limited prognostic value of DSE above RCRI score alone for predicting post-transplant mortality. Inadequate DSE was frequent and extended LT wait times. Further research is necessary to define clinically relevant subgroups and refine CV risk assessment in LT candidates.

Circulation, Volume 150, Issue Suppl_1, Page A4143328-A4143328, November 12, 2024. Background:Direct current cardioversion (DCCV) carries a risk of stroke in atrial fibrillation (AF) patients. Hence, published guidelines for mitigating this risk with oral anticoagulation (OAC). There is no consensus agreement on the safest approach when cardioverting patients with left atrial appendage occlusion device in situ.Aims:We aimed to compare association of pre-DCCV imaging with safety and outcomes in patients with WATCHMAN™ undergoing elective DCCV for atrial arrhythmias (AA)Methods:This was a retrospective cohort study of patients who received DCCV for AA during follow up after LAAO procedure from 2016-2024 within a large health care system. Safety endpoint was freedom from stroke, all-cause mortality, device embolism, and systemic embolism within 30-days post DCCV. Significant peri-device leak (PDL) was defined as > 5mm on cardiac imaging.Results:A total of 119 patients were included, more females 70 (59%), with more than half (64 (54%)) receiving a first-generation WATCHMAN™ 2.5, while the rest had WATCHMAN FLX™. Median age at presentation was 77 years (72,82), BMI of 31 kg/m2 (26,37), average CHADSVASC score of 4.5 and HASBLED score of 3. There was a median duration of 10 months (3,21) between LAAO to presentation for DCCV .Forty-four (37%) patients had pre-DCCV imaging, while 75 patients did not receive pre-procedural imaging. Between the two groups, there was no significant difference in OAC (VKA-antagonist/DOAC) usage prior to presentation (8 (18.6%) vs 12 (16.4%), P=0.9), with single antiplatelet therapy was the prevalent anti-thrombotic regimen. There was no significant difference in CHADSVASC, HASBLED, age, LVEF, or timing of presentation relative to the LAAO procedure. Higher percentage of patients were discharged on OAC post DCCV in the imaging cohort (13 (30.2%) vs 14 (19.4%), p=0.27), the difference was not significant. No Device related thrombus (DRT) nor significant PDL was detected on imaging. But non-significant PDL ranging from 2mm-4.7mm was found in 8 (18.1%) out of 44 patients who had imaging prior to DDCV. Safety endpoint was achieved in both cohorts with zero adverse events occurring during the 30 day follow up period post-DCCV.Conclusion:Elective cardioversion for atrial arrhythmias is safe in patients with WATCHMAN™. There were no post-DCCV stroke events in the overall cohort and no DRT identified in the pre-DCCV imaging subgroup. Further studies are needed to determine when pre-DCCV imaging is warranted in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4136013-A4136013, November 12, 2024. Introduction:The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further.Methods:Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them.Results:Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p

Circulation, Volume 150, Issue Suppl_1, Page A4147168-A4147168, November 12, 2024. Background:Mitral stenosis (MS) is associated with adverse left atrial (LA) structural changes. Mechanical relief of this obstruction via balloon mitral valvuloplasty (BMV) may be associated with LA reverse remodelling.Objective:To study LA and RV remodelling in isolated severe rheumatic MS patients before and 9-12 months after successful BMV.Methods:We included 49 patients with isolated severe rheumatic MS in sinus rhythm who underwent successful BMV. CMR was done at baseline and 9-12 months post BMV. Thirty age- and gender- matched healthy controls were included for comparison. Indexed LA volumes (Vmax, Vmin,&Vpre-A) were obtained from CMR cine images. LA phasic functions were evaluated using both volumetric and deformation indices. Deformation analysis including LA strain (global, passive,&active strain)&strain rate (SRs, SRe, and SRa ) measurements were performed using specialized MASS (R) software for CMR feature tracking.Results:At baseline, there was significant impairment of LA volumes and functions in severe MS patients compared to healthy controls. Following BMV, there was statistically significant reduction in all LA indexed volumes compared to baseline (p-value

Circulation, Volume 150, Issue Suppl_1, Page ASa105-ASa105, November 12, 2024. After the implemetation of special emergency services, advanced airway management(AAM) in cardiac arrest has been tried actively. We aim to compare the success rates and patient outcomes of supraglottic airway(SGA), endotracheal intubation with direct laryngoscope(ETI with DL), and endotracheal intubation with video laryngoscope(ETI with VL) in patients with sudden cardiac arrest, and evaluate the effectiveness of the video laryngoscope in the pre-hospital stage.This study was conducted on cardiac arrest patients who transferred to ED by EMS from July 2019 to December 2021. Using the Korean OHCA registry, EMS ambulance runsheet, and cardiac arrest in-depth registry, patients with sudden cardiac arrest over 18 years old, caused by medical cause, and who were treated by the special EMS team at the site and got AAM were enrolled. Cases with unknown information on AAM success or time of arrival/death were excluded. Pre-hospital ROSC, 72 hr survival, survival to discharge, good neurological outcome were compared among SGA, ETI with DL and ETI with VL using multivariable logistic regression. Initial AAM success and final success rates were also compared.10,587 cases were enrolled in the study, of which 9379 cases got SGA, 493 ETI with DL, and 985 ETI with VL. In the first attempt, the insertion success rate is higher with SGA, but the overall success is higher with VL. For any prehospital ROSC, compared to SGA, ETI with DL was 1.33 (1.00-1.75), and ETI with VL was 1.92 (1.57-2.34). Compared to SGA, aOR for survival within 72 hours was 1.13 (0.81-1.56), 1.34 (1.06-1.70), survival to discharge was 1.05 (0.64-1.65), 1.06 (0.74-1.49), and good neurological outcome was 0.64 (0.31-1.25), 1.17(0.71-1.86) in ETI with DL or ETI with VL respectively. Compared to the SGA, aOR of the initial success was 0.44 (0.32-0.61) and 0.48 (0.38-0.62) in the ETI with DL and ETI with VL groups, respectively, and the final success rate was 0.78 (0.45-1.44), 1.14 (0.72-1.94).Endotracheal intubation in EMS showed the lower initial success rate than SGA, but when using a video-laryngoscope, the final success rate rises to a sufficiently similar level, and the pre-hospital ROSC success rate is higher than that of SGA.

Circulation, Volume 150, Issue Suppl_1, Page A4137708-A4137708, November 12, 2024. Introduction:Intravenous hydration and contrast media volume reduction are the most important preventive factors against CI-AKI after PCI. Multiple studies have demonstrated the effectiveness of intravenous hydration before PCI, however, varied hydration protocols have rather complicated standardization. Doctors’ preferences and local institutional factors further hinder protocol implementation, resulting in reduced compliance.Hypothesis:Standardizing hydration protocol increases the compliance rate of preprocedural hydration orders and administration, reducing the incidence of CI-AKI.Methods:A team at Memorial Hermann The Woodlands Medical Center, comprising a cardiovascular nurse coordinator, catheterization laboratory director, pharmacist, information technologist, and hospital administrators, was formed to improve PCI outcomes through a multi-faceted approach. This involved a standardized hydration protocol with direct education, continuous monitoring, and repeated internal feedback, reviewed monthly. The new protocol included normal saline pre- and post-procedure maintenance fluids, with a 250 ml normal saline bolus pre-operatively. Maintenance fluids were set at 75 ml/hr, and 20 ml/hr for patients with congestive heart failure and an ejection fraction ≤ 40%. The team reviewed 233 patients under the old protocol and 281 under the new protocol. Compliance rates of pre-procedural intravenous hydration were compared and CI-AKI incidence, defined as a >50% increase or a 0.3 mg/dL increase in creatinine levels within 5 days post-procedure, was assessed. Chi square tests and t-tests were used to compare cohorts on 12 parameters and CI-AKI incidence assessment, with a p-value of 0.05.Results:Compliance with pre-procedural hydration significantly increased under the new protocol (86.1% vs 55.4%, p

Circulation, Volume 150, Issue Suppl_1, Page A4144997-A4144997, November 12, 2024. Introduction:Myocardial injury in patients hospitalized with acute on chronic heart failure concurrent with index SARS-CoV-2 (CoV-2) infection is well described, though studies incorporating pre- and post-acute COVID-19 (PAC) are lacking. We address this gap by estimating intensity of acutely decompensated heart failure (ADHF) using time-series pro-BNP levels across hospitalizations pre- vs. respectively index and initial readmission (PAC1).Hypothesis:Case time series analysis will reveal association (p

Circulation, Volume 150, Issue Suppl_1, Page A4134668-A4134668, November 12, 2024. Background:Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling.Method:In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI.Results:A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was – 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P < 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3).Conclusion:At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).

Circulation, Volume 150, Issue Suppl_1, Page A4140776-A4140776, November 12, 2024. Introduction:Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with advanced heart failure (AHF). Among AHF patients, atrial fibrillation (AF) is a common arrhythmia. Despite its prevalence, the impact of pre-existing AF on outcomes in post-LVAD recipients is poorly understood.Hypothesis:LVAD recipients with preexisting AF have higher all-cause mortality.Methods:This is a single-center, retrospective review of 573 LVAD recipients. Patients with LVADs implanted elsewhere, implants prior to 2011, implantation of an unconventional LVAD (e.g. artificial heart), and those with insufficient records were excluded. Univariate descriptive statistics and multivariate logistic&linear regression analyses of patient all-cause mortality, as appropriate, were performed using STATA. Significance was determined at alpha < 0.05.Results:Pre-implant AF was seen in 54% of LVAD recipients. Participants with AF were more likely to be male and older. They had higher rates of hyperlipidemia, prior stroke or TIA, prior CABG, pre-existing ICD at time of implant, and pre-LVAD sustained VT (Table 1). After a median follow-up time of approximately 2 years, 57% of patients died, 22% were transplanted, 9% were explanted, and 12% were lost to follow up. Irrespective of incidence of pre-LVAD AF, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). Pre-LVAD AF was associated with increased mortality (61% vs 47%, p= 0.001). This finding remained significant on multivariate analysis while controlling for other comorbidities (Table 2). Additionally, presence of AF was significantly associated with an increased occurrence of both post-implant VT (63% vs 43%, p

Circulation, Volume 150, Issue Suppl_1, Page A4141265-A4141265, November 12, 2024. Background:Congenital heart disease (CHD) is a common congenital anomaly with lesions requiring intervention before initial hospital discharge defined as critical CHD (CCHD). Advances in prenatal detection, surgical, and post-operative care have improved early survival of patients with CCHD, yet long-term survival is limited. Fetal echocardiography has improved diagnosis and characterization of CCHD, and prenatal palliative care (PC) consult can improve shared decision making, communication, and parental stress of patients with life-limiting conditions. We hypothesized that the utilization of prenatal PC consults for patients with CCHD would be low (

Circulation, Volume 150, Issue Suppl_1, Page A4140752-A4140752, November 12, 2024. Background:Pre-eclampsia is a major cause of maternal and neonatal morbidity and mortality and impacts 5-7% of pregnancies. Randomized trials have shown that aspirin reduces the risk of pre-eclampsia by 10-20%. In 2018, ACOG recommended the use of aspirin in high-risk women and “consideration” in those with moderate risk factors, which would newly include African American race. We sought to determine the proportion of women at risk for pre-eclampsia in the US receiving aspirin and how new guidelines impacted use.Methods:We used survey data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey conducted by the CDC of ambulatory health visits. We assessed visits of pregnant women from 2014-6 and 2018-9 and examined aspirin use according to pre-eclampsia risk status. High-risk includes those with hypertension, diabetes, or chronic kidney disease; medium-risk includes those with >=2 of the following: Black race, low socioeconomic status (identified by Medicaid enrollment), obesity, and age >=35. To determine if aspirin use was well-captured, we tested validity using coronary heart disease.Results:We identified 3,362 visits among pregnant women 2014-9, of which 8.3% occurred with high-risk women (Table 1). Aspirin use increased modestly at visits among low- and medium-risk women after guideline publication, to 1.7% (95% CI 0.5-3.9%) of visits in 2018-9. In contrast, aspirin use increased substantially at visits with high-risk women, though still remained low at 12.3% (95% CI 3.9-27%).Conclusions:Aspirin is an inexpensive and accessible intervention to reduce pre-eclampsia, a driver of adverse pregnancy outcomes and observed racial disparities. Aspirin use in moderate-risk women had minimal change over the time period, suggesting little immediate impact of the 2018 guidelines. Use in high-risk women increased significantly, but still remains low. Systematic efforts to ensure widespread and equitable use of this therapy are needed.

Circulation, Volume 150, Issue Suppl_1, Page A4139646-A4139646, November 12, 2024. Background:Heart failure (HF) affects 6.7 million Americans and causes 500,000 deaths annually. Despite advancements in treatment, the 1-year mortality in advanced HF is 25-50%. Implantable left ventricular assist devices (LVAD) are critical for bridge-to-transplant or destination therapy, with 1-year and 2-year survival rates of 80% and 70%, respectively. At least 67% of LVAD patients have palliative care (PC) needs. However, PC involvement rates have been variable. The aim of this study is to measure the utilization of PC focusing on demographic disparities.Methods:Data was obtained from the National Inpatient Sample (NIS) 2021 database to identify patients with a principal diagnosis of HF (ICD I50.xx), secondary diagnoses of LVAD placement (Z45.2, Z95.811) and utilization of PC during encounter (Z51.5). Analysis was performed using SPSS statistical software.Results:Out of 5,688,355 adult hospitalizations in 2021, 1,048,573 patients were hospitalized with a primary diagnosis of HF. About 7.46% of HF patients received PC. Among these, patients over 75 years old, who constituted 44.4% of the cohort, accounted for 62.6% of PC involvement. PC consultation rates were similar between sexes. White patients made up 67.8% of the HF population but represented 73.6% of PC consultations, while other minority groups had a lower proportion of PC consultations.LVADs were implanted in 0.09% of HF patients, with 69.5% between 50-74 years old. A significant gender disparity was noted; 76.6% of LVAD recipients were male, and 23.4% female.PC was only involved in the care of 17.2% of LVAD patients. Age distribution of LVAD patients PC mirrored the overall LVAD cohort. Gender disparity persisted, with 80.4% of LVAD patients receiving PC being male, and 19.6% female. Racial disparities were less pronounced in this group.Conclusion:Despite proven benefits of PC involvement on the quality of life, psychological well being, and advanced care planning, specific guidelines in LVAD patients are yet to be established. This study underscores the need for more comprehensive guidelines promoting PC integration in the management of LVAD patients, and highlights demographic disparities in PC utilization among HF and LVAD patients.

Circulation, Volume 150, Issue Suppl_1, Page A4147316-A4147316, November 12, 2024. Background:Outpatient palliative care has been associated with improved health-related quality-of-life (HRQoL) in patients with heart failure. However, there is limited understanding of its utilization among patients with long-term left ventricular assist device (LT-LVAD) therapy. The prevalence of LVAD implantation as long-term therapy has increased over the past decade; these patients may particularly benefit from outpatient palliative care.Objective:To identify the predictors of outpatient palliative care utilization in a sample of LT-LVAD patients from a high-volume LVAD center.Methods:This retrospective chart review analyzed data from 270 patients who received LVAD as long-term therapy between January 1, 2017, and December 30, 2021, and were supported on LVAD therapy for at least two years. Patients who received heart transplantation prior to the study end-date were excluded. Logistic regression models were used to estimate the odds of receiving outpatient palliative care (with or without inpatient palliative care) versus receiving inpatient palliative care alone.Results:Among 270 patients, the mean age was 62 years (+/- 12), 74.2% were male, 79.0% Black and 17.3% White. By device: 77.4% received HeartMate 3™ (HM3), 19.6% HVAD™ LVAD, 3.0% HeartMate II™. Patients lived an average of 4 years (+/- 1) post-implantation. The mean number of hospitalizations from implantation to death or end-of-study was 7.85 (+/- 7.04). 180 patients received inpatient palliative care consultation alone; 90 patients received at least one outpatient palliative care visit. Black patients had increased odds of receiving outpatient palliative care compared to White patients (OR 2.27, P=0.040). For each additional hospitalization a patient experienced, the odds of receiving outpatient palliative care increased (OR 1.06, P=0.002). Patients with HVAD™ LVAD were less likely to receive outpatient palliative care than those with HM3 (OR 0.45, P=0.029).Conclusion:In this large cohort of patients supported on LT-LVAD therapy, Black patients were more likely to receive outpatient palliative care than White patients. More frequent hospitalizations and LVAD type were associated with an increased likelihood of outpatient palliative care visits. Future studies should explore the factors contributing to these differences to better understand and enhance palliative care utilization for all patients on LT-LVAD therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4143804-A4143804, November 12, 2024. Introduction:Palliative care interventions for patients with heart failure have been shown to significantly improve quality of life, reduce symptom burden, and enhance functional status. Timing of referral becomes challenging as disease progresses and readmission rates increase. We studied factors associated with inpatient mortality in patients with end stage heart failure, ineligible for additional advanced therapies.Methods:Individuals with acute decompensated heart failure admitted between 2021-2023, who were ineligible for further advanced cardiac therapies and referred to palliative care, were included to this retrospective study. Data on demographic variables, clinical parameters (NYHA classification, Karnofsky Performance Scale (KPS) scores, comorbidities, type of heart disease, BNP, albumin, creatinine levels), and palliative care interventions (symptom burden assessments, family meetings, and advanced care planning (ACP) discussions) were collected. We conducted bivariate and multivariate analyses using Kruskal-Wallis and chi-square tests, and adjusted regression models to compare characteristics between individuals who died while admitted and survivors.Results:A total of 97 individuals were included in the study, with a mean age of 68 ± 17.7 years, 33.0%(n=32) of whom were female. Patients who died during admission had significantly higher rate of established ACP following palliative care consult (p< 0.01) and had a shorter time from consultation to discharge and were more likely to be declared DNR/DNI during admission. Hospital length of stay was shorter for patients who died in the hospital Lower KPS scores, with KPS scores