Improving End-of-Life Care for Patients in Australian Cardiology Wards: A Retrospective Medical Record Audit

BACKGROUND & AIM: Dynamic hospital settings such as cardiology wards face challenges in delivering high-quality end-of-life care due to high patient volumes, urgent clinical demands, variable disease trajectories, and time pressures, often resulting in delayed goals-of-care discussions and suboptimal care. Despite the availability of national End-of-Life Care Standards and associated quality audit tools, evidence describing their use and end-of-life care practices in Australian cardiology wards remains limited. We aimed to examine end-of-life care in cardiology wards within Australian hospitals. METHOD: A retrospective medical record audit was conducted using the Australian Commission on Safety and Quality in Health Care's End-of-Life Audit Tool. The audit included 150 consecutive adult patients who died on cardiology wards across three Australian hospitals between February 2023 and February 2025. RESULTS: The median age of patients at death was 81 years, with 8.7% (n=13) having a documented Advance Care Directive during the admission. Following admission to cardiology wards, 64.7% of patients were recognised as dying, with the average time between recognition of dying to death being 28 hours. The majority (n=134) of patients had a documented resuscitation plan and 70% were referred to palliative care during their final hospital admission. In their final 48 hours of life, 76% (n=114) of patients received active investigations and/or interventions, whilst 41.7% of those identified as dying more than 48 hours before death also continued to receive active interventions and/or investigations in the last 2 days of life. CONCLUSIONS: This study highlights that whilst some elements of high-quality end-of-life care are being provided in cardiology wards, earlier recognition of dying, improved adherence to evidence-based care and more proactive communication are needed to achieve alignment with the national standards.