News in Brief: Campaign to tackle misunderstandings of palliative care; VITT – it’s complicated; Anticoagulants underused in people with mental health diagnosis

Thursday, 27 May 2021

Survey highlights limited community understanding of palliative care

A national campaign is to challenge public perceptions about palliative care to emphasise that it should be considered as early as possible in terminal illness. 

The campaign, called Palliative Care, its more than you think, was developed by Palliative Care Australia (PCA) after survey findings revealed that many Australians don’t understand the broader meaning of palliative care and are reluctant to engage in conversations on death and dying.

Fewer than four out of ten Australians (39%) correctly understand that palliative care can be requested when a person is first diagnosed with a terminal, chronic or degenerative illness. And only three out of ten Australians surveyed correctly understand that GPs are among those who can provide palliative care.

Meanwhile 54% of respondents believe that talking about their preferences for the end of their life with their family will upset them and 48% find the subject of death and planning for the end of their life too difficult to talk about.

PCA Chair Professor Meera Agar said the campaign will challenge perceptions that palliative care is a ‘last resort’.

“The campaign is aimed at informing, empowering and encouraging Australians living with a life-limiting illness to engage with their health care professionals early in their diagnosis, so as to live as well as possible for as long as possible … it can be provided alongside curative treatments, or when those treatments have ended,” Professor Agar said.

Stage one of the campaign will see it roll out nationally on television, in print and online from this week.

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VITT – it’s complicated

Haematologists in Australia, the US and Italy have documented the ‘complicated’ relationship between heparin-induced thrombocytopenia (HIT) and platelet factor 4 (PF4) antibodies in COVID-19 following an extensive literature review.

The research team led by Dr Emmanuel  Favaloro from the Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR) were prompted to conduct the review following several reports of platelet factor 4/heparin (PF4/H) antibodies being present in COVID-19- infected patients.

Writing in International Journal of Laboratory Hematology the group concludes that development of the antibodies is not a feature of COVID-19 – at least for some patients – but that does not always indicate pathological HIT.

The group also says there appears to be a question over the role of heparin in some of the reported cases – which also occurred in several heparin- naïve  patients, suggesting that a “HIT- like” event may be occurring in some patients without heparin exposure.

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Anticoagulants underused in people with mental health diagnosis

Patients with atrial fibrillation and psychiatric comorbidity, including bipolar disorder and schizophrenia, are less likely to receive anticoagulation for stroke prevention a Danish cohort study shows.

Investigators found that both bipolar disorder and schizophrenia were associated with lower frequency of oral anticoagulation therapy (OAT) initiation after an incident AF diagnosis (bipolar disorder, −12.7% and schizophrenia, −24.5%) as well as lower use of OAT in patients with prevalent AF (bipolar disorder, −11.6% and schizophrenia, −21.6%).

But while patients with comorbid AF and bipolar disorder were increasingly likely to receive OAT over time once DOACs were introduced, the treatment disparity persisted in individuals with comorbid schizophrenia, say investigators who also found that patients with schizophrenia were more likely than the reference group to die following their index hospitalization with AF before initiating OAT.

Clinical concerns for OAT not being prescribed could be related to increased alcohol use, poorer anticoagulation control for patients receiving a vitamin K antagonist, and greater likelihood of receiving antidepressants with anticoagulant effects, suggest investigators.

Investigators say more research is needed to examine whether improved care for individuals with severe mental illnesses and comorbid AF reduces this health care disparity.

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