Katie J Wiskar1, Leo Anthony Celi2, Robert C McDermid3, Keith R Walley4,5, James A Russell4,5, John H Boyd4,5, Barret Rush2,3,5,6. 1. 1 Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. 2 Beth Israel Deaconess Medical Center, Boston, MA, USA. 3. 3 Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada. 4. 4 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada. 5. 5 Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 6. 6 Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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.
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.
Entities:
Keywords:
United States; cohort study; epidemiology; health services accessibility; heart failure; palliative care
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