Better deaths from chronic heart failure are possible

A palliative care approach is becoming more common in the terminal admission for patients with chronic heart failure (CHF) though there is still room for improvement.

A review of more than 500 CHF deaths over a decade at the Royal Melbourne Hospital found overall most patients (81.2%) did not receive life-sustaining interventions during their terminal admission.

About half (50.9%) were referred to specialist palliative care during their admission and a third (33.1%) were managed by the inpatient palliative care team.

Patients who died between 2015-2019 were significantly more likely to receive palliation than those who died between 2010-2014 (OR 1.5); have palliative goals of care within 24 hours of admission (OR 9.1), and have documentation of that discussion with family involvement (OR 6.0).

“Despite these positive findings, a palliative approach was often instituted in the final days of life, with a change in the goals of care occurring a median of one day prior to death,” the study said.

“The earlier recognition of the terminal phase, to facilitate provision of an appropriate palliative approach remains a challenge.”

Read more in Heart, Lung and Circulation

Registry will expand knowledge of congenital heart disease

The Australian New Zealand Congenital Heart Disease Registry has been established to help inform the best possible care to a growing population.

The Registry, championed by the Congenital Heart Alliance of Australia and New Zealand (CHAANZ), will help monitor long term outcomes in affected individuals well beyond childhood.

“A National CHD Registry will help doctors and researchers better understand the disease, track its prevalence, the burden on the health system and the outcomes of people living with the condition,” said Registry Chairman Professor David Celermajer.

“Children with CHD receive superb care when young, but as they become teenagers more than half get lost in the system when their care is transferred from a children’s hospital to an adult one.”

He said children who once had a short life expectancy were growing older, having families and leading longer lives with CHD; but also living with complex health problems.

Male doctors won’t shave facial hair for N95 masks

Almost half the male hospital staff required to wear a P2/N95 respirator during the COVID-19 pandemic have beards or facial hair that would potentially render them ineffective, an audit carried out in a Victorian tertiary centre has found.

Despite successfully completing fit testing with a clean shaven face in the preceding year, 45% of the 110 male staff working in three critical areas of a hospital (ICU, ED and operating theatres) were observed to have beards or to not be clean shaven in the face seal zone of their respirators.

The study authors said it was imperative that clinical staff were clean shaven in the face seal zone of their respirators so they are fit-for-purpose and ready to respond during periods of significant community transmission of COVID-19.

“Health care organisations allowing employees to have facial hair where N95 protection is required may be breaching their duty of care under OHS laws,” they said.

Male staff “experiencing a loss of identity or significant skin irritation with daily shaving should be supported so that their respiratory protection is optimised, not only to protect themselves from harm, but also to safeguard those they work with and care for,” they added.

Read more in Infection, Disease & Health