456 Palliative Care Interventions for Peripheral Vascular Disease: A Systematic Review

Abstract Objective Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD). Background PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse. Method A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded. Results A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate. Conclusions Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.