To determine the rate and predictors of palliative care referral (PCR) in hospitalized patients with acute heart failure (AHF).
Introduction:
The PCR is commonly utilized in terminal conditions such as metastatic cancers. There is no data on trends and predictors from large-scale registry of general population regarding PCR in patients with AHF.
Methods:
For this retrospective study, data were obtained from National Inpatient Sample Database from 2010 to 2014. We used International Classification of Diseases, Ninth Revision diagnosis codes to identify cases with a principle diagnosis of AHF. These patients were divided into 2 groups: (1) PCR, (2) no PCR groups. We performed multivariate analysis to identify predictors of PCRs, as well as reported PCR trends from 2010 to 2014.
Results:
From the database, out of 37 312 324 hospitalizations, 621 947 unweighted cases with primary diagnosis of AHF were selected for further analysis. About 2.8% received PCR. From 2010 to 2014, there was an uptrend from 2.0% to 3.6% for PCR. Metastatic cancer, ventilator-dependent respiratory failure, and cardiogenic shock were strongly associated with PCR. Those who underwent percutaneous coronary intervention and African American or other races were negative predictors for PCR. In the PCR group, 31.4% of patients died during hospitalization.
Conclusion:
Palliative care referrals were made in a very small proportion of patients with AHF. We observed steady rise in the PCR utilization. Chronic conditions, advancing age, and high-risk patients were major predictors of PCR.
RosensteinDL. Depression and end-of-life care for patients with cancer. Dialogues Clin Neurosci. 2011;13(1):101–108.
2.
RomeRBLuminaisHHBourgeoisDABlaisCM. The role of palliative care at the end of life. Ochsner J. 2011;11(4):348–352.
3.
GoldfingerJZAdlerED. End-of-life options for patients with advanced heart failure. Curr Heart Fail Rep. 2010;7(3):140–147.
4.
RobinsonMRAl-KindiSGOliveiraGH. Trends in palliative care use in elderly men and women with severe heart failure in the United States. JAMA Cardiol. 2017;2(3):344.
5.
RogersJGPatelCBMentzRJ. Palliative care in heart failure: the PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol. 2017;70(3):331–341.
6.
SahlenKGBomanKBrannstromM. A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial. Palliat Med. 2016;30(3):296–302.
7.
WiskarKCeliLAWalleyKRFruhstorferCRushB. Inpatient palliative care referral and 9-month hospital readmission in patients with congestive heart failure: a linked nationwide analysis. J Intern Med. 2017;282(5):445–451.
8.
National Inpatient Sample. Healthcare Cost and Utilization Project 2010-2014. Agency for Healthcare Research and Quality, 2016. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Updated September 13, 2018. Accessed October 10, 2017.
9.
The Web’s Free ICD-9-CM Medical Coding Reference. http://www.icd9data.com/. Accessed October 20, 2018.
10.
ElixhauserASteinerCHarrisDRCoffeyRM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.
11.
FederSLRedekerNSJeonS. Validation of the ICD-9 diagnostic code for palliative care in patients hospitalized with heart failure within the veterans health administration. Am J Hosp Palliat Care. 2018;35(7):959–965.
12.
MulveyCLSmithTJGourinCG. Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer. Head Neck. 2016;38(3):355–363.
MeierDE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343–380.
15.
BlindermanCDBillingsJA. Comfort care for patients dying in the hospital. N Engl J Med. 2015;373(26):2549–2561.
16.
HoppFPThorntonNMartinL. The lived experience of heart failure at the end of life: a systematic literature review. Health Soc Work. 2010;35(2):109–117.
17.
SidebottomACJorgensonARichardsHKirvenJSillahA. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med. 2015;18(2):134–142.
18.
GomesBCalanzaniNCurialeVMcCronePHigginsonIJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013;(6):CD007760.
19.
PattendenJFMasonARLewinRJ. Collaborative palliative care for advanced heart failure: outcomes and costs from the ‘Better Together’ pilot study. BMJ Support Palliat Care. 2013;3(1):69–76.
20.
GreenerDTQuillTAmirOSzydlowskiJGramlingRE. Palliative care referral among patients hospitalized with advanced heart failure. J Palliat Med. 2014;17(10):1115–1120.
21.
MandawatAHeidenreichPAMandawatABhattDL. Trends in palliative care use in veterans with severe heart failure using a large national cohort. JAMA Cardiol. 2016;1(5):617–619.
22.
RileyJPBeattieJM. Palliative care in heart failure: facts and numbers. ESC Heart Fail. 2017;4(2):81–87.
23.
O’ConnorCMHasselbladVMehtaRH. Triage after hospitalization with advanced heart failure: the ESCAPE risk model and discharge score. J Am Coll Cardiol. 2010;55(9):872–878.
24.
FonarowGCAdamsKFJrAbrahamWTYancyCWBoscardinWJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572–580.
25.
LevyWCMozaffarianDLinkerDT. The seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113(11):1424–1433.
26.
YerganJFloodABLoGerfoJPDiehrP. Relationship between patient race and the intensity of hospital services. Med Care. 1987;25(7):592–603.
27.
CaralisPVDavisBWrightKMarcialE. The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia. J Clin Ethics. 1993;4(2):155–165.
28.
JohnsonKS. Racial and ethnic disparities in palliative care. J Palliat Med. 2013;16(11):1329–1334.
29.
BekelmanDBHuttEMasoudiFAKutnerJSRumsfeldJS. Defining the role of palliative care in older adults with heart failure. Int J Cardiol. 2008;125(2):183–190.
30.
LustbaderDPekmezarisRFrankenthalerM. Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients. Palliat Support Care. 2011;9(4):401–406.
31.
LemondLAllenLA. Palliative care and hospice in advanced heart failure. Prog Cardiovasc Dis. 2011;54(2):168–178.
32.
AdlerEDGoldfingerJZKalmanJParkMEMeierDE. Palliative care in the treatment of advanced heart failure. Circulation. 2009;120(25):2597–2606.
33.
ReynoldsKButlerMGKimesTMRosalesAGChanWNicholsGA. Relation of acute heart failure hospital length of stay to subsequent readmission and all-cause mortality. Am J Cardiol. 2015;116(3):400–405.
YancyCWJessupMBozkurtB; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):1495–1539.
