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A Miller, N Patel, 2759 Cardiogeriatrics—what is the impact on end of life Care for Older Cardiology Patients?, Age and Ageing, Volume 54, Issue Supplement_1, January 2025, afae277.051, https://doi.org/10.1093/ageing/afae277.051
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Abstract
Royal Bolton Hospital is a district general hospital in Greater Manchester. In 2023, a Cardiogeriatrics service was introduced to deliver comprehensive geriatric assessment for older cardiology inpatients with frailty.
Our aim was to evaluate the Cardiogeriatrics service with respect to the impact on end-of-life care for older cardiology inpatients.
Audit standards were defined using metrics for quality in end-of-life e care. All patients between the year 2021 and 2024 aged 75 and over who died as an inpatient or within 30 days of discharge were included. Patients who died following procedural interventions were excluded. Patient’s casenotes were audited and compared before and after the initiation of the service.
Casenotes for 88 inpatient deaths were audited (66 prior to introduction of the Cardiogeriatric service, 22 following). The Cardiogeriatrician initiated end of life care in 31.6% of inpatient deaths. This corresponded with a reduction in unexpected deaths from 25.8% to 13.6%, and a reduction in patients initiated on end-of-life care by the on-call team, from 28.6% to 10.5%. Junior doctors on Cardiology began to initiate resuscitation conversations with patients. Casenotes for 44 deaths within 30 days of discharge were audited. The majority (72.1%) of discharges were via standard discharge pathways rather than palliative pathways.
After introduction of the Cardiogeriatrics service, there was improved recognition of patients who were approaching end of life, and more proactive management of this. As many patients audited were not seen directly by the Cardiogeriatrician, we believe the service has contributed to a cultural change in the Cardiology team more widely towards more proactive recognition and management of end-of-life issues in older Cardiology patients. There remains a need for better utilisation of palliative discharge pathways and we plan to address this through further quality improvement work.
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