Distinct Perceptions of Cardiologists and Palliative Care Physicians on Heart Diseases Patients: Knowledge Integration Opportunity

Abstract

Introduction: Among the conditions requiring Palliative Care (PC), cardiovascular diseases have recently received increased attention. The difficulty in recognizing terminality in heart diseases has been indicated as a factor compromising the quality of end-of-life care. Objective: The aim of this study is to evaluate the perceptions of cardiologists (C) regarding mortality expectations and the need for PC for patients with advanced and/or terminal heart disease. Method: This is a prospective observational study in which demographic and clinical data were collected from patients admitted to a cardiology center on a single day. The cardiologists attending these patients answered a questionnaire with two “surprise questions” related to the expected mortality within a year and during the current hospitalization. Based on the response patterns, patients were classified into profiles: evolving/advanced non-terminal disease (I/II), terminality (III), and end-of-life phase (IV). Additionally, cardiologists were asked about the need for PC for each patient. A palliative care physician (P) answered the same "surprise questions" based on data from the medical records. Results: A total of 242 patients (90% of those hospitalized) were evaluated, of whom 34 died during hospitalization. The cardiologists and the palliative care physician classified 35.5% and 4.1% of patients as profile IV, with correct prediction of mortality during hospitalization at 32.6% and 70%, respectively. Cardiologists recognized the need for PC for 93 patients but requested palliative care evaluation for only 13 (14%). Conclusion: Following the observation of outcomes, it is noted that the palliative care physician more accurately predicts patient mortality. Although cardiologists recognize the need for PC, they request specialty consultations for only a minority of patients, highlighting the need for greater collaboration between cardiologists and palliative care physicians.