Abstract
Traditionally, palliative care was thought to play a role when “end of life” measures are considered. This paradigm has shifted, with several studies showing the need for early palliative care and its positive impact on quality of life in patients with advanced heart failure (AHF). Palliative care should be provided early in the course of the disease trajectory and integrated with other disease modifying therapies. We sought to characterize the practice of palliative care consultations (PCC) for patients with AHF in a safety-net hospital.
We conducted a retrospective chart review of all HF admissions from October 1, 2016 to September 30, 2017 and identified those who received PCC. Using a severity of illness (SOI) index, determined by the presence of comorbidities, we selected patients with major or extreme SOI. Patients were stratified by length of stay, ICU admission and costs of admission. Analysis was done using Chi-square or Fisher's exact test as appropriate for categorical variables, or student's t test for normally distributed continuous variables (p-level of < 0.05).
We analyzed a total of 786 admissions for HF with major or extreme SOI over the 1-year period. We identified 60 patients with a total of 94 admissions who received PCC and 520 HF patient without PCC (692 total admissions). In the PCC group, mean age was 65 years, 45% were females, and 92% were African Americans (Table 1). The PCC group was older, had higher SOI and higher cost per admission than the total HF group (Table 1). PCC was mostly utilized as an end of life measure with odds ratio of death/hospice of 17.1 (95% CI: 8.9-33.2) in the PCC group compared to patients without PCC, even when the ICU admission rate was the same between the two groups (Fig 1).
PCC is being utilized late in the management of AHF patients, despite HF guidelines recommending early involvement for symptom management and advance care planning. Early PCC may allow for incorporation of palliative care services, thus improving the quality of life for patients with AHF.