Journal of cardiac failure · 2025
Implementing HeartPal: Design and Early Results of a Specialized Care Delivery Model for Advancing Palliative Care in Advanced Heart Disease Populations.
СтатьяНазвание и аннотация: Перевод в очереди
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Jain Nelia, Santo Eilann C, Lehto Hanna-Riikka, Schaefer Kristen G, Manning Katharine A, Landzberg Michael J, Warraich Haider J, Givertz Michael M, Mehra Mandeep R, Tulsky James A, Desai Akshay S
Аннотация
BACKGROUND: Patients with advanced heart disease (AHD) face a high symptom burden and complex care decisions with inconsistent access to palliative care (PC). We describe the design, implementation, and early outcomes of HeartPal, a specialty-aligned interprofessional PC service embedded within an AHD program, to inform replication in similar settings.
METHODS AND RESULTS: Launched in 2019, HeartPal includes a nurse practitioner, social worker, and PC physician delivering longitudinal care across inpatient and outpatient settings. We analyzed registry data from 505 patients referred between 2019 and 2021, fiscal year (FY) 2024 data, and service operational metrics. Monthly referrals increased from 13.2 to 19.3 patients (+46.2%). Referrals for advanced therapy evaluations decreased from 76 in 158 (48.1%) to 26 in 174 (14.9%), and goals-of-care referrals increased from 79 in 158 (50.0%) to 145 in 174 (83.3%). Among decedents, referrals within 60 days of death decreased by 47.1%. In-hospital deaths after the index admission decreased from 24 to 15 (-37.5%), and clinic follow-up increased from 23 in 142 (16.2%) to 34 in 158 (21.5%). In fiscal year 2024, the team completed 837 encounters, generating 2,063 relative value units. Billing offset 20% of the direct personnel costs.
CONCLUSIONS: HeartPal illustrates the feasibility of embedding PC within AHD care pathways, while highlighting the critical need for institutional investment.
METHODS AND RESULTS: Launched in 2019, HeartPal includes a nurse practitioner, social worker, and PC physician delivering longitudinal care across inpatient and outpatient settings. We analyzed registry data from 505 patients referred between 2019 and 2021, fiscal year (FY) 2024 data, and service operational metrics. Monthly referrals increased from 13.2 to 19.3 patients (+46.2%). Referrals for advanced therapy evaluations decreased from 76 in 158 (48.1%) to 26 in 174 (14.9%), and goals-of-care referrals increased from 79 in 158 (50.0%) to 145 in 174 (83.3%). Among decedents, referrals within 60 days of death decreased by 47.1%. In-hospital deaths after the index admission decreased from 24 to 15 (-37.5%), and clinic follow-up increased from 23 in 142 (16.2%) to 34 in 158 (21.5%). In fiscal year 2024, the team completed 837 encounters, generating 2,063 relative value units. Billing offset 20% of the direct personnel costs.
CONCLUSIONS: HeartPal illustrates the feasibility of embedding PC within AHD care pathways, while highlighting the critical need for institutional investment.