75 Non-Cancer Presentations with a Median Survival of Six Months or Less

Heart Failure

  • Hospitalization for moderate to severe symptomatic heart failure (HF), NYHA (New York Heart Association) Class III or IV with three or more of the following:
    • Age > 70
    • Left Ventricular Ejection Fraction (LVEF) 20% or less
    • Beta-type Natriuretic Peptide (BNP) > 950
    • Cardiac troponin I > 0.4
    • C-reactive protein > 3.5
    • 4th hospitalization for CHF or repeat hospitalization within 2 months
    • Dependency of 3 or more ADL (activities of daily living) or need for home care
    • Weight loss of 2.3 kg or greater in 2 months or albumin< 2.5
    • History of:
      • Cardiogenic shock
      • Ventricular or supraventricular arrhythmia
      • Cardiac arrest
      • Cardiopulmonary resuscitation or
      • Mechanical ventilation
    • Systolic blood pressure < 110
    • Creatinine > 2 or BUN > 40
    • Sodium < 135
    • Cardiovascular disease:
      • Ischemic cerebrovascular disease or
      • Peripheral vascular disease
    • Other comorbid illness:
      • Diabetes
      • Mellitus
      • Dementia
      • COPD
      • Cirrhosis
      • Cancer

Dementia

  • Advanced dementia with dependency in all activities of daily living, bedbound status, urinary and bowel incontinence, decreased ability to communicate verbally, AND admission to a hospital or skilled nursing facility with one or more of the following:
    • BMI < 18.5, decreased oral intake, or significant weight loss
    • Presence of at least one pressure ulcer
    • Evidence of at least one comorbid illness
    • Male sex and age > 90
    • Placement of a feeding tube due to inability to eat or history of aspiration

Geriatric Failure-to-Thrive

  • Age > 75, albumin < 3.5, dependency in 2 or more activities of daily living, AND admission to a hospital or skilled nursing facility with one or more of the following:
    • Dependency in all activities of daily living with malnutrition (weight loss >10% or albumin < 3)
    • Evidence of heart failure
    • Creatinine > 3
    • Evidence of delirium during hospitalization

End-Stage Renal Disease (ESRD)

  • ESRD on dialysis with age > 70 and 2 or more of the following:
    • KPS < 50
    • Significant comorbid condition such as
      • Coronary artery disease
      • Peripheral vascular disease
      • Heart failure
      • Cancer
    • Malnutrition
      • BMI < 19.5 or albumin < 2.2
    • Residence in a skilled nursing facility
    • Admission to an intensive care unit for an acute illness
    • Hip fracture with inability to ambulate
  • ESRD without dialysis with age > 70 and 1 or more of the following:
    • Dialysis withheld due to decreased performance status and significant comorbidity
    • Dialysis withdrawn due to advanced age, functional dependence, and comorbidity

Cirrhosis

  • Decompensated hepatic cirrhosis and 1 or more of the following:
    • Child-Pugh 12 or greater
    • MELD 21 or greater
  • Decompensated hepatic cirrhosis with hospitalization for an acute illness related to liver disease and 1 or more of the following:
    • Child-Pugh 10 or greater
    • MELD 18 or greater
    • Child-Pugh 9 or greater AND dependency in 3 or more ADL AND malnutrition (significant weight loss and albumin < 2.5
    • Hospitalization in an intensive care unit related to severe decompensation of liver disease, with hypotension requiring the use of vasopressors, creatinine > 1.5, OR evidence of jaundice
    • Evidence of hepatopulmonary syndrome or rapidly progressive hepatorenal syndrome

Chronic Obstructive Pulmonary Disease (COPD)

  • Hospitalization for a severe COPD exacerbation with hypoxemia (paO2 < 55), hypercapnia (pCO2 > 50), dependence on supplemental O2, and 3 or more of the following:
    • Age > 70
    • Evidence of cor pulmonale
    • Repeat hospitalization within 2 months
    • History of intubation/mechanical ventilation
    • KPS < 60
    • Need for home care after discharge
    • Malnutrition (weight loss > 2.3 kg, albumin < 2.5, or BMI < 18)
    • Creatinine > 2

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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