{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:51:15Z","timestamp":1787637075372,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"unspecified","delay-in-days":177,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,6,6]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prognostic value in various medical settings but remains understudied in cardiac intensive care units (CICUs). This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a single-centre, prospective, observational study at the Maggiore Hospital in Bologna, including 1131 patients admitted to the CICU between August 2022 and November 2023. Patients were stratified into two groups based on their PPS at admission (\u226470\u2009and &gt;70). Multivariable regression models were used to assess predictors of mortality, and Kaplan-Meier survival curves were generated. Model accuracy and calibration were evaluated using receiver operating characteristic curves and the Hosmer-Lemeshow test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Patients with PPS \u226470 had significantly higher 1-year all-cause mortality (37.0% vs 9.8%, p&lt;0.001) and in-hospital all-cause mortality (17.7% vs 3.3%, p&lt;0.001). In the multivariable regression models, PPS emerged as an independent predictor of both 1-year and in-hospital all-cause mortality, along with age and Sequential Organ Failure Assessment score. The models demonstrated good discriminatory performance (area under the curve of 0.841 for 1-year mortality, 0.862 for in-hospital mortality) and acceptable calibration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003302","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T14:40:29Z","timestamp":1751035229000},"page":"e003302","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Palliative Performance Scale predicts mortality in cardiac intensive care unit"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4454-1864","authenticated-orcid":false,"given":"Laura Sofia","family":"Cardelli","sequence":"first","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"},{"name":"Cardiology Department, Ospedale Versilia, Lido di Camaiore, Toscana, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4364-9163","authenticated-orcid":false,"given":"Lorenzo","family":"Gamberini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5515-853X","authenticated-orcid":false,"given":"Beatrice","family":"Dal Passo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Universit\u00e0 degli Studi di Ferrara, Ferrara, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7357-7578","authenticated-orcid":false,"given":"Silvia","family":"Zagnoni","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Sciarra","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3166-0542","authenticated-orcid":false,"given":"Federica","family":"Frascaro","sequence":"additional","affiliation":[{"name":"Cardiology Department, Universit\u00e0 degli Studi di Ferrara, Ferrara, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Vitagliano","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Carinci","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Laura","family":"Canale","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Versilia, Lido di Camaiore, Toscana, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni","family":"Casella","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"2025081709584557000_12.1.e003302.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000350"},{"key":"2025081709584557000_12.1.e003302.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000741"},{"key":"2025081709584557000_12.1.e003302.3","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/jgs.12142","article-title":"Patient-Centered Care for Older Adults with Multiple Chronic Conditions: These are the Polypathological Patients!","volume":"61","author":"Bernabeu-Wittel","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"2025081709584557000_12.1.e003302.4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/CIA.S365968","article-title":"Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges","volume":"18","author":"Brunker","year":"2023","journal-title":"Clin 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The clinical evaluation of chemotherapeutic agents in cancer. 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Palliative care integration into outpatient heart failure management: pilot study. 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