Abstract
Background: Heart failure (HF) carries a high symptom burden and mortality (Fernandes Pedro & Reis-Pina, 2022). Despite guideline support for early palliative care (PC), referral remains low. The Chang et al., 2022 criteria were developed to enable rapid (Chang et al., 2022), nurse-led screening of patients with advanced HF, but their clinical performance is unclear. This study examined PC referral patterns among hospitalized HF patients and evaluated the diagnostic accuracy and agreement of these criteria.
Methods: We conducted a retrospective case–control study using 2023–2024 electronic medical records from a tertiary hospital. Adults admitted with a principal diagnosis of HF were included. PC referral was identified by documented inpatient consultation. All patients were screened using the Chang et al., 2022 criteria (≥1 item positive = referral indicated). Six-month survival was used as an indicator of high PC need. Agreement statistics and logistic regression were used to assess concordance and identify predictors of referral.
Results: Among 450 patients, 54 (12.0%) received PC. Metastatic cancer (OR 9.67), NYHA class (OR 3.38), and HF stage (OR 2.91) were strong predictors of referral. Although 65.1% screened positive, only 18.4% were referred. Concordance between clinician judgement and the criteria was low (Kappa = 0.136), and agreement with six-month survival was poor (Kappa = −0.184). Only 32.6% of patients who died within six months received PC. The criteria showed high sensitivity (95.9%) and negative predictive value (96.8%) but low specificity (46.3%).
Conclusions: Hospitalized HF patients with high short-term mortality risk were frequently under-referred to PC. The Chang et al., 2022 criteria provide a sensitive, practical tool that allows nurses and advanced practice nurses to rapidly identify unmet PC needs and standardize referral, reducing variation and supporting earlier integration of PC into HF care.
Notes
References:
1. Chang, Y. K., Allen, L. A., McClung, J. A., Denvir, M. A., Philip, J., Mori, M., Perez-Cruz, P., Cheng, S. Y., Collins, A., & Hui, D. (2022). Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care. J Am Coll Cardiol, 80(4), 332–344. https://doi.org/10.1016/j.jacc.2022.04.057
2. Fernandes Pedro, J., & Reis-Pina, P. (2022). Palliative Care in Patients with Advanced Heart Failure: A Systematic Review. Acta Med Port, 35(2), 111–118. https://doi.org/10.20344/amp.15963
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Retrospective
Research Approach
Quantitative Research
Keywords:
Palliative Care, Palliative Treatment, Heart Failure, Heart Failure Patients, Diagnosis, Medical Referrals
Recommended Citation
Chen, Yi-Wen; Tang, Chia Chun; Huang, Hsien-Liang; Chen, Jui-Yi; Wang, Pei-Yi; Chen, Shan-Ting; and Lee, Ching-Yi, "Clinical Performance of Heart Failure Palliative Care Referral Criteria: A Retrospective Study" (2026). International Nursing Research Congress (INRC). 77.
https://www.sigmarepository.org/inrc/2026/posters_2026/77
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-26
Clinical Performance of Heart Failure Palliative Care Referral Criteria: A Retrospective Study
Toronto, Ontario, Canada
Background: Heart failure (HF) carries a high symptom burden and mortality (Fernandes Pedro & Reis-Pina, 2022). Despite guideline support for early palliative care (PC), referral remains low. The Chang et al., 2022 criteria were developed to enable rapid (Chang et al., 2022), nurse-led screening of patients with advanced HF, but their clinical performance is unclear. This study examined PC referral patterns among hospitalized HF patients and evaluated the diagnostic accuracy and agreement of these criteria.
Methods: We conducted a retrospective case–control study using 2023–2024 electronic medical records from a tertiary hospital. Adults admitted with a principal diagnosis of HF were included. PC referral was identified by documented inpatient consultation. All patients were screened using the Chang et al., 2022 criteria (≥1 item positive = referral indicated). Six-month survival was used as an indicator of high PC need. Agreement statistics and logistic regression were used to assess concordance and identify predictors of referral.
Results: Among 450 patients, 54 (12.0%) received PC. Metastatic cancer (OR 9.67), NYHA class (OR 3.38), and HF stage (OR 2.91) were strong predictors of referral. Although 65.1% screened positive, only 18.4% were referred. Concordance between clinician judgement and the criteria was low (Kappa = 0.136), and agreement with six-month survival was poor (Kappa = −0.184). Only 32.6% of patients who died within six months received PC. The criteria showed high sensitivity (95.9%) and negative predictive value (96.8%) but low specificity (46.3%).
Conclusions: Hospitalized HF patients with high short-term mortality risk were frequently under-referred to PC. The Chang et al., 2022 criteria provide a sensitive, practical tool that allows nurses and advanced practice nurses to rapidly identify unmet PC needs and standardize referral, reducing variation and supporting earlier integration of PC into HF care.
Description
This retrospective study examined palliative care referral patterns and the performance of the Chang et al., 2022 criteria among hospitalized heart failure patients. Referral was infrequent, agreement with the criteria and six-month survival was poor, and many high-risk patients were not referred. The highly sensitive criteria support nurse-led screening to standardize and advance timely PC referral.