Guidelines advocate for integrating palliative care into the management of heart failure (HF) and of children with life-limiting disease. The potential impact of palliative care integration into pediatric HF on patient-centered outcomes is poorly understood. The present study sought to assess the association of programmatic implementation of palliative care into the heart transplant evaluation process with hospital-free days (HFD) and end of life (EOL) treatment choices. The study included patients less than 19 years of age who underwent a heart transplant evaluation between February 2012 and April 2020 at a single center. Patients evaluated in the programmatic palliative care (PPC) era (January 2016–April 2020) were compared to patients evaluated in the pre-PPC era (February 2012–December 2015). The study included 188 patients, with 91 (48%) in the PPC era and 97 (52%) in the pre-PCC era. Children < 1 year of age at the time of the evaluation represented 32% of the cohort. 52% of patients had single ventricle physiology. PPC was not significantly associated with increased HFD (IRR 0.94 [95% CI 0.79–1.2]). PPC was however associated with intensity of EOL care with decreased mechanical ventilation (OR 0.12 [95% CI 0.02–0.789], p = 0.03) and decreased use of ionotropic support (OR 0.13 [95% CI 0.02-0.85], p =0.03). PPC in pediatric heart transplant evaluations may be associated with less invasive interventions at EOL.

指南主张将姑息治疗纳入心力衰竭（HF）和患有生命限制性疾病的儿童的治疗中。人们对将姑息治疗纳入儿科心力衰竭对以患者为中心的结果的潜在影响知之甚少。本研究旨在评估心脏移植评估过程中姑息治疗的规划实施与无住院天数 (HFD) 和临终治疗 (EOL) 治疗选择之间的关系。该研究纳入了 2012 年 2 月至 2020 年 4 月期间在单一中心接受心脏移植评估的 19 岁以下患者。将程序化姑息治疗 (PPC) 时代（2016 年 1 月至 2020 年 4 月）评估的患者与前 PPC 时代（2012 年 2 月至 2015 年 12 月）评估的患者进行比较。该研究包括 188 名患者，其中 91 名 (48%) 处于 PPC 时代，97 名 (52%) 处于 PCC 之前时代。评估时年龄小于 1 岁的儿童占该群体的 32%。52%的患者有单心室生理。PPC 与 HFD 增加没有显着相关性（IRR 0.94 [95% CI 0.79–1.2]）。然而，PPC 与 EOL 护理强度相关，包括机械通气减少（OR 0.12 [95% CI 0.02-0.789]，p = 0.03）和离子型支持使用减少（OR 0.13 [95% CI 0.02-0.85]，p = 0.03） ）。儿科心脏移植评估中的 PPC 可能与 EOL 时的侵入性较小的干预措施有关。