Palliative care burden and specialist service utilisation for individuals with cardiovascular disease in Australia: a national population-based observational study

Background
Cardiovascular disease (CVD) is a major cause of death globally. In advanced stages, patients with CVD often require palliative care due to reduced health-related quality of life from physical, psychological and spiritual symptoms, along with physical disability.

Objectives
To investigate (1) the symptom and function burden of patients with CVD on their first admission to specialist palliative care services and (2) how these care burdens, and other clinical characteristics, affected patients’ utilisation of community-based versus inpatient services.

Design
A national population-based observational study using point-of-care outcomes sourced from the Australian palliative care outcomes and collaboration (PCOC).

Settings
Community-based and inpatient Specialist palliative care services across Australia registered in the PCOC.

Participants
Patients who required specialist palliative care principally for CVD, and whose death occurred between 1 January 2013 and 31 December 2022.

Methods
Five validated clinical instruments were used to collect point-of-care outcomes on each individual’s function (Resource Utilisation Groups – Activities of Daily Living (RUG) & Australia-modified Karnofsky Performance Status (AKPS)), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). Multivariable logistic regression was applied to evaluate how patients’ functional and symptom burden influenced their use of inpatient versus community-based palliative care services.

Results
Our analysis included 17 002 patients with CVD, with 7539 (44.3%) receiving community palliative care services and 9463 (55.7%) accessing inpatient palliative care services. On admission to palliative care services, patients often exhibit significant physical functional impairments and substantial symptom burdens, particularly related to fatigue and breathing difficulties. In comparison, patients accessing inpatient services tended to have greater functional impairment (p

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