Palliative Care In Acute Coronary Syndrome Understudied

MedicalResearch.com Interview with:
Prof. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute University of Zurich Department of Cardiology Clinic St. Anna, Lucerne and University Hospital Zurich Zurich, SwitzerlandProf. Dr. med. Paul Erne
AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute
University of Zurich
Department of Cardiology
Clinic St. Anna, Lucerne and University Hospital Zurich
Zurich, Switzerland

MedicalResearch: What is the background for this study? What are the main findings?

Prof. Erne: Very little is known on this important subgroup of patients with Acute Coronary Syndrome (ACS) at admission who for various reasons receive restricted or palliative treatment only. Reasons for withholding comprehensive and/or invasive therapy may be the very limited life expectancy, advanced age or severe comorbidities. These patients are not represented in prospective trials and often not included in outcome statistics and registries.

This study provides evidence that the population which received palliative therapy is older and sicker when compared to patients who underwent conservative or reperfusion treatment. However, this study shows that these decisions are very individually addressed. Acute Coronary Syndrome patients treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. Changes of treatment decisions over time and the proportion of patients surviving 1 year suggest in part non homogenous and potentially questionable decision criteria. While refraining from more active therapy may be the most humane and appropriate approach in many patients, in others it represents under treatment.

MedicalResearch: What should clinicians and patients take away from your report?

Prof. Erne: Decision making on treatment of patients admitted for Acute Coronary Syndrome with poor prognoses is a great challenge for the clinicians and should be well deliberated and documented to enable in-depth studies of this patient group.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Prof. Erne: This patient group certainly warrants further study and should be included in outcome statistics and registries.

Citation:

Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997–2014

Paul Erne, Dragana Radovanovic, Burkhardt Seifert, Osmund Bertel, Philip Urban, on behalf of the AMIS Plus Investigators

BMJ Open 2015;5:3 e006218 doi:10.1136/bmjopen-2014-006218

 

Prof. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute (2015). Palliative Care In Acute Coronary Syndrome Understudied