Research: Earlier Palliative Care Improves Patient Outcomes in the Cardiac ICU.

Our study of patients in the cardiac intensive care unit at MedStar Washington Hospital Center finds that palliative care positively impacts ICU care.

Patients in the cardiac intensive care unit (ICU) are very sick with life-threatening cardiovascular diseases. The ICU is where patients get intense medical care and is often not a place where palliative care is considered. However, our research—the first to study the impact of palliative care, specifically in the cardiac ICU—finds that these patients have improved patient-centered outcomes in some areas when receiving palliative care services within 72 hours of being admitted to the ICU. 

The research, published in Heart and Lung: The Journal of Cardiopulmonary and Acute Care, answers some questions (and raises others) about how this type of patient-centered care benefits patients and their families.

Palliative care is specialized team care for people with serious illnesses to relieve symptoms and stress and improve quality of life—most associate palliative care with end-of-life terminal diseases. At MedStar Health, palliative care is not prognosis-based—we provide these services, when necessary, not just when patients are nearing the end of their lives. Even in patients where all forms of aggressive care are being delivered, it can potentially benefit. 

Palliative care can help these patients in the ICU manage pain and other disease-related symptoms, navigate complex treatment decisions, and engage in advanced care planning. These patients have conditions such as heart failure, coronary artery disease, cardiac arrhythmias, and other severe heart conditions. Generally, these patients have a high risk of death or developing other severe conditions such as vascular disease, diabetes, and kidney failure.

Communicating with patients and their families lets us know their values and preferences and how they want their medical care to align with their personal goals. We can support them as they manage their illness—as early in their cardiac ICU stay as possible. 

Related reading: In-Hospital Left Ventricular Assist Devices Deactivation and Death Experience: A Single-Institution Retrospective Analysis.

Improving outcomes in the cardiac ICU.

Our retrospective study reviewed the medical records of 209 adult patients admitted to MedStar Washington Hospital Center’s cardiac ICU medical unit between December 2021 and June 2022 who got palliative care.

We compared the outcomes of those who received palliative care consultation earlier than 72 hours after admission and those who received these services later than 72 hours. Their average age was 68, 45% of participants were female, and 62% identified as Black. 

After statistical analysis, our research found early palliative care was associated with:
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• Shorter stays in the ICU

• Higher odds of having a family meeting to discuss their personal goals and how medical care should support achieving those goals

• Less intensive care when that aligned with patient/family preference

Our research also showed that people who got palliative care later were less likely to have invasive procedures as part of their care, including:

• Tracheostomy: A surgical procedure to create an opening in the windpipe to allow breathing through a tube

• Cardioversion: A procedure to use medication or controlled electric shock to restore normal heart rhythm

• Percutaneous endoscopic gastrostomy: A procedure to insert a feeding tube directly into the stomach through the abdomen

While a retrospective study like this can’t say that the timing of palliative care caused these outcomes, it strongly suggests an association. Having time to build a therapeutic relationship with patients and families early on can help them process their critical illness and navigate the complexities of a serious illness. 

Related reading: Research Examines Earlier Equitable Access to Palliative Care Services.

Further questions to explore palliative care timing.

This study reinforced some of what we already knew or expected about the benefits of palliative care based on our experience and prior research. Ultimately, patients and families benefit from collaborative care that addresses what they need and want during serious illness care.

It also led us to some new questions to consider as we prepare for the next study. For instance:
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• Should all patients who are admitted to the cardiac ICU get palliative care? What is the best timing of this intervention?

• What are more specific ways early palliative care consultation can improve the patient experience in the cardiac ICU? Earlier and better symptom management?

• Greater likelihood of completing advance directives?

A future study with a more extensive data set will help us answer these questions. We can also explore whether some groups of patients would benefit more from either a medically focused palliative care team or one with a psychosocial or spiritual focus.

Palliative care is a relatively young field that is growing fast. Studies like this help us understand how to identify the patients who would most benefit from palliative care and how to ensure they get this care when it’s needed most.