A nurse-led heart failure navigator program significantly increased appropriate referral of advanced heart failure patients to palliative care, according to research presented Feb. 14 at ACC's Cardiovascular Summit in Orlando, FL. The secret: the program engaged varied stakeholders, leveraged prospective risk assessment, and incorporated formal education about optimal end-of-life care.

According to Margaret Richter, RN, MSN, CHFN, Linda DeSitter, MD, Adam Mizgajski, MD, and Deborah Strohecker, RN, BSN, the authors of the poster, while palliative care in advanced heart failure patients can improve symptoms and quality of life, it remains significantly underused, or occurs too late into the disease process.

To that end, in 2017, Providence Heart and Vascular Institute-Oregon, starting using a phased implementation approach that started with identifying patients at high-risk for 30-day readmission and having a heart failure nurse navigator prospectively review their charts. A message was then sent to the primary inpatient team via electronic health record requesting a palliative care referral. Phase two of the program, which started in 2018, added more formalized clinician education on the importance of palliative care in cardiology, as well as engagement of palliative care nurses and social workers in triaging palliative care referrals.

The first phase identified 192 high-risk heart failure patients of which 48 received a palliative care referral. Results showed that referral to palliative care was higher among patients evaluated by a heart failure nurse navigator (33 percent) vs. those that were not (23 percent). In the second phase, 221 high-risk heart failure patients were identified, of which 115 were referred to palliative care. Researchers noted that "while referral rates increased among those evaluated by a heart failure nurse navigator (35/81; 43 percent), notable increases were also observed among those that were not (80/140, 57 percent)," suggesting that multi-stakeholder engagement, use of an assessment tool to identify those at highest risk, and formalized education about palliative care was successful.

Keywords: CV Summit, Palliative Care, Patient Readmission, Inpatients, Social Work, Quality of Life, Terminal Care, Heart Failure, Referral and Consultation, Risk Assessment, Electronic Health Records

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