Chapter 10. Integration <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong>to Cardiology EUROPEAN CONTEXT B TECHNICAL DATA ON THE <strong>2019</strong> <strong>EAPC</strong> SURVEY ON PALLIATIVE CARE INTO CARDIOLOGY Population: 54 countries <strong>of</strong> the <strong>Europe</strong> WHO region and Lichtenste<strong>in</strong>. Survey Details Areas explored: 5 <strong>in</strong>dicators on PC provision <strong>in</strong> Cardiology services, <strong>in</strong>clusion <strong>of</strong> PC topics <strong>in</strong> Cardiology congresses (and vice versa), meet<strong>in</strong>gs between experts from the national cardiology and PC associations, and publications on PC provision <strong>in</strong> cardiology services. Questionnaire: on-l<strong>in</strong>e survey, 12 questions, time answered <strong>in</strong> (average) 16 m<strong>in</strong>utes. Participants: 14 national experts <strong>in</strong> <strong>Palliative</strong> <strong>Care</strong> and Cardiology. Pr<strong>of</strong>ile <strong>of</strong> experts (affiliation): 8 from Cardiology Departments (5 Cardiology departments, 3 Cardiology Associations), 5 from PC centres (4 from PC services, 1 from PC Association) and 1 from University . Coverage: 12/54 countries (22%): with one respondent 9/12 (75%) countries, with two respondents 3/12 (25%) Data collection: 12/2018 to 3/<strong>2019</strong> (4 months) Project Management: ATLAN- TES Research Group, Institute for Culture and Society, University <strong>of</strong> Navarra, Pamplona (Navarra), Spa<strong>in</strong> . Scientific Advice: Manuel Martínez Sellés (Spa<strong>in</strong>) y Pablo Díez Villanueva (Spa<strong>in</strong>). Promotor: <strong>Europe</strong>an Association for <strong>Palliative</strong> <strong>Care</strong> (<strong>EAPC</strong>). HEART failure patients may have generic palliative care needs and THEREFORE there exists an <strong>in</strong>creas<strong>in</strong>g conviction that <strong>in</strong> order to enhance care for patients with advanced heart diseases, PALLIATIVE <strong>Care</strong> should become a usual component. Nowadays accord<strong>in</strong>g to the <strong>EAPC</strong> dedicated Taskforce on Heart Failure and the Heart Failure Association <strong>of</strong> the <strong>Europe</strong>an Society <strong>of</strong> Cardiology, just a few people with advanced heart failure and those approach<strong>in</strong>g end <strong>of</strong> life, as well as their families, receive appropriate PC support (1,2). Further exist<strong>in</strong>g <strong>in</strong>formation show that large gaps exist <strong>in</strong> address<strong>in</strong>g symptom burden and PC needs <strong>of</strong> cardiac patients ( 3,4, 5). In consequence, this chapter will <strong>in</strong>tend to provide a view on the degree to which <strong>Palliative</strong> <strong>Care</strong> is <strong>in</strong>tegrated <strong>in</strong>to Cardiology <strong>in</strong> 12 <strong>Europe</strong>an countries (Albania, Czech Republic, Denmark, Germany, Ireland, Italy, Portugal, Spa<strong>in</strong>, Sweden, Switzerland, The Netherlands and the United K<strong>in</strong>gdom) by look<strong>in</strong>g at the very provision <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> cardiology services but also at the level pr<strong>of</strong>essional collaboration between discipl<strong>in</strong>es. In 42 <strong>Europe</strong>an countries the research team was unable to identify a reference person for PC <strong>in</strong> Cardiology. PC Provision <strong>in</strong> Cardiology Services In <strong>Europe</strong>, the provision <strong>of</strong> palliative care for cardiac patients rema<strong>in</strong>s scarce, and solely eight countries report the existence <strong>of</strong> pioneer<strong>in</strong>g cardiology services provid<strong>in</strong>g <strong>Palliative</strong> <strong>Care</strong>. All these countries (Czech Republic, Denmark, Ireland, Portugal, Spa<strong>in</strong>, Sweden, The Netherlands and the United K<strong>in</strong>gdom) identify at least an <strong>in</strong>tegrated service where <strong>of</strong>ten seems to have dedicated protocols for <strong>Palliative</strong> <strong>Care</strong> delivery (Denmark, Italy, Spa<strong>in</strong>, Netherlands and United K<strong>in</strong>gdom). The frequency with which cardiology services and PC pr<strong>of</strong>essionals collaborate is occasional. A higher ratio has been identified <strong>in</strong> Spa<strong>in</strong> and Italy, where good experiences <strong>in</strong> different Eduardo Garralda, Manuel Martínez Selllés, Pablo Díez Villanueva. centres mediated by the oncology experience (Italy) or a close relationship with <strong>in</strong>tra-hospital PC teams (Spa<strong>in</strong>), exist. PC topics <strong>in</strong>clusion <strong>in</strong> National Cardiology Congresses and vice versa <strong>Palliative</strong> care topics have been <strong>in</strong>cluded at least <strong>in</strong> the last three years <strong>in</strong> 11 <strong>Europe</strong>an countries (11/12). The extent to which this is a common issue varies from country to country. The Czech Republic reports the <strong>in</strong>clusion <strong>of</strong> a session on Advanced heart failure and palliative care with four lectures with<strong>in</strong> as an extraord<strong>in</strong>ary and new achievement, whereas Spa<strong>in</strong> for <strong>in</strong>stance, report hav<strong>in</strong>g PC topics <strong>in</strong>cluded every year. Similarly, 10 countries (10/12) report the <strong>in</strong>clusion <strong>of</strong> cardiology topics <strong>in</strong> the National <strong>Palliative</strong> <strong>Care</strong> Congresses <strong>in</strong> the last three years though <strong>in</strong> the perception <strong>of</strong> some respondents <strong>in</strong>clusion <strong>of</strong> Cardiology topics <strong>in</strong> PC Congresses is somehow more difficult than the other way round. Only Italy and Spa<strong>in</strong> report the existence <strong>of</strong> periodical meet<strong>in</strong>gs between experts from the national cardiology and PC association. Publications regard<strong>in</strong>g PC provision <strong>in</strong> Cardiology Services Seven countries report the existence <strong>of</strong> publications regard<strong>in</strong>g palliative care provision <strong>in</strong> cardiology services. The National experts reported diverse amount <strong>of</strong> scientific publications per country, rang<strong>in</strong>g from seven <strong>in</strong> Spa<strong>in</strong>, three <strong>in</strong> the United K<strong>in</strong>gdom, two <strong>in</strong> Italy, and at least one <strong>in</strong> the Czech Republic, Denmark, Portugal, and the Netherlands (a sample <strong>of</strong> some <strong>of</strong> these articles can be seen <strong>in</strong> the bibliographic references´ section). <strong>EAPC</strong> <strong>Atlas</strong> <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> <strong>Europe</strong> 85
EUROPEAN CONTEXT Chapter 10. Integration <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong>to Cardiology B Map 10.1. <strong>Palliative</strong> <strong>Care</strong> provision <strong>in</strong> Cardiology. <strong>EAPC</strong> <strong>Atlas</strong> <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> <strong>Europe</strong> 86
- Page 1 and 2:
B EAPC Atlas of Palliative Care in
- Page 3 and 4:
B EAPC Atlas of Palliative Care in
- Page 5 and 6:
Abstract INTRODUCTION B Background
- Page 7 and 8:
1. Presentation B
- Page 9 and 10:
PRESENTATION Note from the authors
- Page 11 and 12:
PRESENTATION Net of collaborators o
- Page 13 and 14:
PRESENTATION Net of collaborators o
- Page 15 and 16:
PRESENTATION The Atlas project grou
- Page 17 and 18:
2. Aims and objectives B
- Page 19 and 20:
3. Population and methods B
- Page 21 and 22:
EAPC Atlas of Palliative Care in Eu
- Page 23 and 24:
EAPC Atlas of Palliative Care in Eu
- Page 25 and 26: POPULATION AND METHODS Palliative C
- Page 27 and 28: Note 1. Conditions non included in
- Page 29 and 30: METHODS OF THE PROJECT B Step 1: Sy
- Page 31 and 32: METHODS OF THE PROJECT B Step 3: EA
- Page 33 and 34: METHODS OF THE PROJECT B Step 5: Ha
- Page 35 and 36: 4. Development and integration of P
- Page 37 and 38: EUROPEAN CONTEXT Chapter 1. Special
- Page 39 and 40: EUROPEAN CONTEXT Chapter 1. Special
- Page 41 and 42: EUROPEAN CONTEXT Chapter 1. Special
- Page 43 and 44: EUROPEAN CONTEXT Chapter 2. Integra
- Page 45 and 46: EUROPEAN CONTEXT Chapter 2. Integra
- Page 47 and 48: EUROPEAN CONTEXT Chapter 2. Integra
- Page 49 and 50: EUROPEAN CONTEXT Chapter 3. Integra
- Page 51 and 52: EUROPEAN CONTEXT Chapter 3. Integra
- Page 53 and 54: EUROPEAN CONTEXT Chapter 4. Palliat
- Page 55 and 56: EUROPEAN CONTEXT Chapter 4. Palliat
- Page 57 and 58: EUROPEAN CONTEXT Chapter 5. Use of
- Page 59 and 60: EUROPEAN CONTEXT Chapter 5. Use of
- Page 61 and 62: EUROPEAN CONTEXT Chapter 6. Palliat
- Page 63 and 64: EUROPEAN CONTEXT Chapter 6. Palliat
- Page 65 and 66: EUROPEAN CONTEXT Chapter 7. Integra
- Page 67 and 68: EUROPEAN CONTEXT Chapter 7. Integra
- Page 69 and 70: EUROPEAN CONTEXT Chapter 8. Develop
- Page 71 and 72: EUROPEAN CONTEXT Chapter 8. Develop
- Page 73 and 74: EUROPEAN CONTEXT Chapter 9. Integra
- Page 75: EUROPEAN CONTEXT Chapter 9. Integra
- Page 79 and 80: EUROPEAN CONTEXT Chapter 10. Integr
- Page 81 and 82: EUROPEAN CONTEXT Chapter 11. Integr
- Page 83 and 84: EUROPEAN CONTEXT Chapter 11. Integr
- Page 85 and 86: COUNTRY INFORMATION How to read the
- Page 87 and 88: Gross Domestic Product per capita (
- Page 89 and 90: COUNTRY INFORMATION / ARMENIA 9,937
- Page 91 and 92: Gross Domestic Product per capita (
- Page 93 and 94: Gross Domestic Product per capita (
- Page 95 and 96: COUNTRY INFORMATION / BELARUS 5,728
- Page 97 and 98: COUNTRY INFORMATION / BELGIUM 43,32
- Page 99 and 100: Gross Domestic Product per capita (
- Page 101 and 102: Gross Domestic Product per capita (
- Page 103 and 104: COUNTRY INFORMATION / CROATIA 13,38
- Page 105 and 106: Gross Domestic Product per capita (
- Page 107 and 108: COUNTRY INFORMATION / CZECH REPUBLI
- Page 109 and 110: COUNTRY INFORMATION / DENMARK 56,30
- Page 111 and 112: Gross Domestic Product per capita (
- Page 113 and 114: COUNTRY INFORMATION / FINLAND 45,70
- Page 115 and 116: COUNTRY INFORMATION / FRANCE 38,477
- Page 117 and 118: COUNTRY INFORMATION / GEORGIA 4,057
- Page 119 and 120: COUNTRY INFORMATION / GERMANY 44,47
- Page 121 and 122: COUNTRY INFORMATION / GREECE 18,613
- Page 123 and 124: COUNTRY INFORMATION / HUNGARY 14,22
- Page 125 and 126: Gross Domestic Product per capita (
- Page 127 and 128:
COUNTRY INFORMATION / IRELAND 69,33
- Page 129 and 130:
Gross Domestic Product per capita (
- Page 131 and 132:
Gross Domestic Product per capita (
- Page 133 and 134:
Gross Domestic Product per capita (
- Page 135 and 136:
COUNTRY INFORMATION / KYRGYZTAN 1,2
- Page 137 and 138:
COUNTRY INFORMATION / LATVIA 15,594
- Page 139 and 140:
15,594 Gross Domestic Product per c
- Page 141 and 142:
Gross Domestic Product per capita (
- Page 143 and 144:
COUNTRY INFORMATION / LUXEMBOURG 10
- Page 145 and 146:
Gross Domestic Product per capita (
- Page 147 and 148:
Gross Domestic Product per capita (
- Page 149 and 150:
Gross Domestic Product per capita (
- Page 151 and 152:
Gross Domestic Product per capita (
- Page 153 and 154:
Gross Domestic Product per capita (
- Page 155 and 156:
COUNTRY INFORMATION / NETHERLANDS 4
- Page 157 and 158:
Gross Domestic Product per capita (
- Page 159 and 160:
Gross Domestic Product per capita (
- Page 161 and 162:
Gross Domestic Product per capita (
- Page 163 and 164:
Gross Domestic Product per capita (
- Page 165 and 166:
Gross Domestic Product per capita (
- Page 167 and 168:
Gross Domestic Product per capita (
- Page 169 and 170:
Gross Domestic Product per capita (
- Page 171 and 172:
Gross Domestic Product per capita (
- Page 173 and 174:
Gross Domestic Product per capita (
- Page 175 and 176:
Gross Domestic Product per capita (
- Page 177 and 178:
Gross Domestic Product per capita (
- Page 179 and 180:
Gross Domestic Product per capita (
- Page 181 and 182:
COUNTRY INFORMATION / TURKEY 10,546
- Page 183 and 184:
COUNTRY INFORMATION / UKRAINE 2,640
- Page 185 and 186:
Gross Domestic Product per capita (
- Page 187 and 188:
COUNTRY INFORMATION / UZBEKISTAN 1,
- Page 189:
B