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  • Title: Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.
    Author: Wiskar KJ, Celi LA, McDermid RC, Walley KR, Russell JA, Boyd JH, Rush B.
    Journal: Am J Hosp Palliat Care; 2018 Apr; 35(4):620-626. PubMed ID: 28826226.
    Abstract:
    BACKGROUND: Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. AIM: To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. DESIGN: Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. SETTING/PARTICIPANTS: Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. RESULTS: Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P < .01). In comparison, rate of palliative care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P < .01). In a multivariate logistic regression model, higher socioeconomic status (SES) was associated with increased access to palliative care ( P < .01). Racial differences were also observed in rates of referral to palliative care. CONCLUSION: The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.
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