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Prevalence of Sudden Death in Palliative Care : Data From the Australian Palliative Care Outcomes Collaboration

Ekström, Magnus LU ; Vergo, Maxwell T.; Ahmadi, Zainab LU and Currow, David C. (2016) In Journal of Pain and Symptom Management 52(2). p.272-283
Abstract

Context Advanced, life-limiting illnesses are likely to have a predictable functional decline through a terminal phase to death, but some patients may also die suddenly. To date, empirical evidence characterizing “sudden death” in hospice/palliative care is lacking. Objectives The aim of this study was to determine prevalence and clinicodemographic predictors of sudden death in hospice/palliative care. Methods This is a longitudinal consecutive cohort study of prospectively collected national data in 104 specialist palliative care services from the Australian Palliative Care Outcomes Collaboration. Patients who died between July 1, 2013, and June 30, 2014, with one or more measurement of Australian-modified Karnofsky Performance Status... (More)

Context Advanced, life-limiting illnesses are likely to have a predictable functional decline through a terminal phase to death, but some patients may also die suddenly. To date, empirical evidence characterizing “sudden death” in hospice/palliative care is lacking. Objectives The aim of this study was to determine prevalence and clinicodemographic predictors of sudden death in hospice/palliative care. Methods This is a longitudinal consecutive cohort study of prospectively collected national data in 104 specialist palliative care services from the Australian Palliative Care Outcomes Collaboration. Patients who died between July 1, 2013, and June 30, 2014, with one or more measurement of Australian-modified Karnofsky Performance Status (AKPS) in the last 30 days of life were included. “Sudden death” was defined as a lowest AKPS score of 50 or more in the last seven days of life and excluded anyone with “terminal phase” as their last phase before death. Predictors were defined using logistic regression. Results In total, 13,966 patients were included, mean age 73.6 (SD 13.6) years, 46% women, and 77% had cancer. During the seven days before death, there were 20,992 AKPS measurements; median 1 (interquartile range 1–2) per patient. Four percent of deaths (one of 25) were sudden, predicted independently by having lung cancer (odds ratio [OR] 2.64), cardiovascular disease (OR 1.94), other cancers (OR 1.63), being male (OR 1.23), younger, worse fatigue, and worse breathlessness. Sudden death was associated with higher rates of death at home (OR 3.2; 95% CI 2.9 to 3.6). Conclusion This study quantifies rates of sudden death in hospice/palliative care and has implications for conversations about prognosis between clinicians, patients, and their families.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
breathlessness, fatigue, lung cancer, palliative care, performance status, Sudden death
in
Journal of Pain and Symptom Management
volume
52
issue
2
pages
12 pages
publisher
Elsevier
external identifiers
  • Scopus:84983048201
ISSN
0885-3924
DOI
10.1016/j.jpainsymman.2016.02.015
language
English
LU publication?
yes
id
aab83735-6783-4799-a5f5-33818590ac63
date added to LUP
2016-09-20 17:54:07
date last changed
2016-09-21 03:00:02
@misc{aab83735-6783-4799-a5f5-33818590ac63,
  abstract     = {<p>Context Advanced, life-limiting illnesses are likely to have a predictable functional decline through a terminal phase to death, but some patients may also die suddenly. To date, empirical evidence characterizing “sudden death” in hospice/palliative care is lacking. Objectives The aim of this study was to determine prevalence and clinicodemographic predictors of sudden death in hospice/palliative care. Methods This is a longitudinal consecutive cohort study of prospectively collected national data in 104 specialist palliative care services from the Australian Palliative Care Outcomes Collaboration. Patients who died between July 1, 2013, and June 30, 2014, with one or more measurement of Australian-modified Karnofsky Performance Status (AKPS) in the last 30 days of life were included. “Sudden death” was defined as a lowest AKPS score of 50 or more in the last seven days of life and excluded anyone with “terminal phase” as their last phase before death. Predictors were defined using logistic regression. Results In total, 13,966 patients were included, mean age 73.6 (SD 13.6) years, 46% women, and 77% had cancer. During the seven days before death, there were 20,992 AKPS measurements; median 1 (interquartile range 1–2) per patient. Four percent of deaths (one of 25) were sudden, predicted independently by having lung cancer (odds ratio [OR] 2.64), cardiovascular disease (OR 1.94), other cancers (OR 1.63), being male (OR 1.23), younger, worse fatigue, and worse breathlessness. Sudden death was associated with higher rates of death at home (OR 3.2; 95% CI 2.9 to 3.6). Conclusion This study quantifies rates of sudden death in hospice/palliative care and has implications for conversations about prognosis between clinicians, patients, and their families.</p>},
  author       = {Ekström, Magnus and Vergo, Maxwell T. and Ahmadi, Zainab and Currow, David C.},
  issn         = {0885-3924},
  keyword      = {breathlessness,fatigue,lung cancer,palliative care,performance status,Sudden death},
  language     = {eng},
  month        = {08},
  number       = {2},
  pages        = {272--283},
  publisher    = {ARRAY(0xc0ebd00)},
  series       = {Journal of Pain and Symptom Management},
  title        = {Prevalence of Sudden Death in Palliative Care : Data From the Australian Palliative Care Outcomes Collaboration},
  url          = {http://dx.doi.org/10.1016/j.jpainsymman.2016.02.015},
  volume       = {52},
  year         = {2016},
}