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Current status of palliative care for heart failure; from the clinical experience of a general hospital in Japan

Session Poster Session 4

Speaker Yosuke Nishihata

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : Y Nishihata (Tokyo,JP), N Komiyama (Tokyo,JP)

Authors:
Y Nishihata1 , N Komiyama1 , 1St. Luke's International Hospital - Tokyo - Japan ,

Citation:

Background: Palliative care (PC) for advanced heart failure (HF) was added as medical treatment fee from April 2018 in Japan, but there are some gap in clinical needs and the criteria to taking cost of PC-addition of medical insurance in Japan. We assessed current status of PC for HF and contrasted with the criteria for PC-addition of medical insurance in Japan.

Methods: Between April 2015 and March 2018, there were 894 patients consulted to PC team for any disease in our hospital and 499 patients who admitted to our hospital for HF. We extracted 21 patients with advanced HF who was consulted to PC team, and we examined patients characteristics to contrast with the criteria for PC-addition of medical insurance in Japan; 1) optimal medical therapy, 2) NYHA 4, 3) more than two times of hospitalization for HF within 1 year, 4) left ventricular ejection fraction (LVEF) = 20%, 5) end-stage.

Results: Their mean age was 78.4-years-old and 13 patients (61.9%) were male. All of them were optimally treated but remained NYHA 4, and 16 patients (76.2%) were first-time hospitalization for HF within 1 year. Their median LVEF was 50.7% and only 3 patients (14.3%) were below LVEF 20%. 16 patients (76.2%) were considered as end-stage but the other 5 were not. As a result of those, only 4 patients (19%) were met to the criteria for PC-addition and the other 17 were not met. As a content of PC, 19 patients (90%) underwent symptomatic relief by opioids, and 8 of them withdrew from opioids.

Conclusions: Our data demonstrates that there is obvious gap between clinical needs of PC for HF and the criteria for PC-addition of medical insurance in Japan. We should take appropriate care of patients without being bound by the criteria for PC-addition of medical insurance in Japan.

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