Palliative care integration into outpatient heart failure management: pilot study
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".