{
  "abstract": "Objectives People with heart failure have palliative care needs yet services remain underused. The heart failure clinic is a potential setting for initial palliative care delivery though evidence for such services is lacking. We explored the outcomes of an embedded model of palliative medicine within a heart failure clinic.Methods We conducted a retrospective cohort study of individuals who received a palliative medicine consultation in a heart failure clinic. Descriptive statistics were used to characterise the cohort and their outcomes, and the McNemar test to compare rates of advance care planning before/after consultation.Results Majority of individuals who received a palliative medicine consultation experienced New York Heart Association (NYHA) class II symptoms (65.5%) and had a Palliative Performance Scale score of≥60% (66.8%). While only 17% engaged in advance care planning in the year before consultation, 93% had advance care planning during the first consultation (p<0.001). Care was provided in multiple domains including advance care planning (95%), symptom management (97%) and caregiver support (30%), regardless of the reason for referral.Conclusions Our embedded model of palliative medicine within the heart failure clinic was associated with increased advance care planning at a time when patients were functional and minimally symptomatic. Further research should substantiate these findings at other sites.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Shamara Nadarajah"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Palliative Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada",
        "Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Giovanna Sirianni"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Stephanie Poon"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Palliative Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Michael Bonares"
    }
  ],
  "title": "Palliative care integration into outpatient heart failure management: pilot study",
  "uid": "67e99c81-da9a-5705-9eba-ba5c1e7c77a2"
}