Although many patients may discontinue cardiac medications upon admission to palliative care, a recent study shows that those who continued them had less respiratory distress and required lower oral morphine equivalents (OMEs). The study was presented at the CHEST Annual Meeting in Boston, Massachusetts.
“It is currently unclear what role cardiac medications have for symptom management and outcomes for patients with cardiovascular disease at the end of life,” wrote the authors, led by Steven Saunders. “Most of the literature concerning management of end-of-life symptoms provides general advice, focusing on the use of medications such as opioids, sedatives, anticholinergics, antipyretics, antipsychotics, and antinausea medications to treat pain, dyspnea, delirium, and secretions.”
The authors sought to clarify the effects of cardiac medications on symptoms in a palliative population. They conducted a retrospective chart review of 176 patients admitted to a palliative care unit at a 766-bed quaternary care academic center between 2019 and 2020. Included patients (average age, 80.9 years; 50% male; 69.9% White) had a cardiac diagnosis and died within an average of 14 days of admission to the unit.
The researchers collected data on cardiac medications prescribed, timing of discontinuation, medications for symptom management, OME use, and scores on the Respiratory Distress Observations Scale (RDOS) and Pain Assessment in Advanced Dementia (PAINAD) Scale.
The study found that only 24.4% of patients continued cardiac medications. The length of stay was similar between those who continued and those who discontinued. However, the analysis revealed that patients who continued the medications were less likely to have high scores on the ROS and PAINAD (1.2% RDOS ≥ 4 [representing moderate respiratory distress] and 2.9% PAINAD ≥ 6 [representing moderate to severe pain]), compared to those who discontinued (12% RDOS ≥ 4 and 5.7% PAINAD ≥ 6).
Patients who continued also had significantly lower average OME use during the first day in the palliative care unit (54.29 mg for the continuation group vs 56.49 mg for the discontinuation group) and the last day (84.42 mg for the continuation vs 131.35 mg for the discontinuation) (P=0.031).
“Our study provides important insights into utilization patterns of cardiac medications in patients with cardiac disease during the end of life. It also suggests that continuing these medications may contribute to improved symptom control, as evidenced by lower rates of moderate respiratory distress and moderate to severe pain compared to patients who discontinued their medications,” the authors concluded. They called for future research and guidelines for this patient population.
Reference
Saunders S, Chin J, Khanijo S,et al. Should we continue cardiac medications during end-of-life care? Abstract# A5058. Presented at the CHEST Annual Meeting; October 6-9, 2024; Boston, Massachusetts.
