Palliative care in the current management of heart failure- a matched case-control, retrospective cohort study in England
Bibliographic record
Abstract
Abstract Introduction Heart failure (HF) represents a major global healthcare burden. In patients with ongoing symptoms despite optimal treatment, palliative care (PC) is expected to improve coordination of care and thereby, patient orientated outcomes, but current utilisation patterns are not well-studied. Methods Using linked electronic health records from England (Clinical Practice Research Datalink), of individuals aged ≥18 years with incident HF, we assessed predictors of receiving palliative care following HF diagnosis using Kaplan-Meier estimates and Cox regression models. We matched HF patients who received PC with those who did not (on age at HF diagnosis, sex, region, year of HF diagnosis and history of cancer at HF diagnosis) to compare risks of cardiovascular and all-cause hospitalisation and mortality in follow-up. Results We included 36,358 individuals with HF who did not receive PC during follow-up and 6,991 individuals who did. Higher age at HF diagnosis, and the presence of comorbidities including type 2 diabetes, hypertension, chronic kidney disease and cancer were associated with higher likelihood of receiving PC. 5,911 PC cases and 16,893 controls were included in the matched analysis. PC utilisation varied greatly across the UK. Estimated adjusted hazard ratios for all-cause hospitalisation were higher in people not receiving PC: 1.42 (1.32, 1.53), as were HF hospitalisation: 1.27 (1.19, 1.35), all-cause mortality: 2.66 (2.53, 2.80) and cardiovascular mortality: 2.16 (2.00, 2.33). Interpretation: In individuals with HF, PC has the potential to reduce important patient-orientated outcomes and thereby improve quality of life in the later stages of the disease. Importantly, despite these positive expected outcomes, PC is currently rarely utilised. There are likely to be opportunities to use PC earlier in HF trajectories, but unmeasured confounding or confounding by indication in observational data and the lack of patient-level measures of quality of life, complicate the estimation of potential benefits of PC in HF and underscore the need for future clinical trials.Characteristics by palliative care use
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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 source (direct Gemma or distilled Codex), 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".