Palliative care for patients with cardiovascular disease and COVID-19 in a major referral hospital

Abstract

Introduction: COVID-19 disease has a wide spectrum of severity, ranging from asymptomatic to severe acute respiratory syndrome. Although the estimated mortality is around 3% in the general population, individuals with comorbidities such as cardiovascular disease (CVD) may develop worse virus-related outcomes and have higher mortality rates. Furthermore, triage systems in pandemics may have low sensitivity to the need for palliative care, leaving many patients without appropriate end-of-life support. Purpose: The aim of this study was to evaluate the palliative care offered to patients with CVD and COVID-19 in a major referral hospital in Brazil. Methods: Descriptive and retrospective study of adult patients with CVD and COVID-19 admitted to a major referral hospital in Brazil. Medical records of patients with CVD and COVID-19 were reviewed. Patients were screened for the need for palliative care through the Supportive and Palliative Care Indicators Tool (SPICT). Pearson's chi-squared tests were performed and p < 0.05 was considered statistically significant. Results: The sample was composed of 526 (53.6%) males and 456 (46.4%) females. Median [IQR] age was 65 [55-73] years old. Regarding department of admission, 194 (19.8%) patients were admitted to the wards, 359 (36.5%) to the emergency room (ER), and 429 (43.7%) to the intensive care unit (ICU). Regarding SPICT criteria, 285 (29%) were at risk of deteriorating and dying. Palliative care was offered to 82 (8.4%) patients. From the patients who met SPICT criteria (n = 285), only 64 (22.5%) had access to palliative care during hospitalization. Patients who received palliative care were more likely to be ≥60 years old, to meet SPICT criteria, and to die (p < 0,001) (Table). Sex and department of admission were not associated with the likelihood of receiving palliative care (Table). Regarding outcomes, 356 patients died (36.3%), 573 were discharged (58.3%), and 53 (5.4%) were transferred to another unit. From the patients who died (n = 356), only 65 (18.3%) had access to palliative care. Conclusions: In our study, there was a high mortality rate in patients with CVD and COVID-19, although a considerable proportion of them did not have access to palliative care before dying. It is important to give further attention to the end-of-life support offered to patients with CVD and COVID-19. (Figure Presented).