End of life care and advance care planning for outpatients with inoperable aortic aneurysms

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DAVIES, Henry | VLEUGELS, Marie-José | KWAN, Jing Yi | AERDEN, Alexander | WYLD, Lucy | FAWCETT, Lee-Ellen | ANTHONY, Rebecca | KHAN, Assad | WALLACE, Tom | VAN DEN BEUKEN-VAN EVERDINGEN, Marieke | SCHURINK, Geert Willem | MEES, Barend M. E. | SCOTT, D. Julian A.

OBJECTIVE: A significant proportion of patients with abdominal and thoracic aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, until this study, there exist no studies on the end of life care conservatively managed patients receive. DESIGN: This is a retrospective multicentre cohort study of 220 conservatively managed AA patients referred to Leeds Vascular Institute (UK) and Maastricht University Medical Centre (Netherlands) for intervention between 2017 and 2021. METHODS: Demographic details, mortality, cause of death, advance care planning and palliative care outcomes were analysed to examine predictors of palliative care referral and efficacy of palliative care consultation. RESULTS: A total of 1506 AA patients were seen over this time period, giving a non-intervention rate of 15%. There was a 3-year mortality rate of 55%, a median survival of 364 days and rupture was the reported cause of death in 18% of the decedents. Median follow up was 34 months. Only 8% of all patients and 16% of decedents received palliative care consultation, which took place a median of 3.5 days before death. Patients over 81 years of age were more likely to have advance care planning. Only 5% and 23% of conservatively managed patients had documentation of preferred place of death and care priorities respectively. Patients with palliative care consultation were more likely to have these in place. CONCLUSION: Only a small proportion of conservatively treated patients had advance care planning and this was far below international guidelines on end of life care for adults, which recommend it for each of these patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention receive end of life care and advance care planning.

http://dx.doi.org/10.1016/j.jvs.2023.04.015

Voir la revue «Journal of vascular surgery»

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