Limited progress in patients with acute myocardial infarction (MI) has been achieved over the past two decades.
The following data speaks to this issue.
• Despite advances in treatment, rates of in-hospital mortality have remained at about 5% with acute MI and 30% to 40% in those with cardiogenic shock.
• The overall incidence of palliative care was low, only 1.3%. Rates among patients with high-risk features was 6.5% for cardiogenic shock, 5.4% for mechanical complications, and 4.9% for cardiac arrest.
• Palliative care encounters increased mainly among patients who died in hospital, where rates jumped from 1.5% to 31.6%. Penetration also increased among high-risk patients, particularly those with cardiogenic shock (0.6% to 14%).
In current thinking, palliative care and acute myocardial infarction are words that classically don't go together. Aggressive therapy will be appropriate for most patients with an acute MI, but it's important to keep in mind the option of palliative care if things don't go well or if treatment is believed to be futile.
Identified barriers to integrate palliative care are: lack of knowledge and skills among treating physicians; an opinion that intensive care and palliative care are sequential and mutually exclusive; and unrealistic expectations of patients, family, and physicians regarding treatment.
Having physicians with expertise in dealing with these issues – and able to offer other options – can make patients more comfortable without necessarily reducing care.
This information is from studies in high-income countries, but it may be also useful for countries in other socioeconomic levels.
See reference for more information.
Adapted from Medscape News & Perspective. Modest inroads made for palliative care in acute MI. Internet. Available at https://www.medscape.com/viewarticle/923652. Accessed on January 25, 2020. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.