Abstract 13065: Trends, Predictors and Outcomes in Heart Failure Patients undergoing Palliative Care
Background: Palliative care improves quality of life and potentially survival in advanced heart failure patients but is underutilized. Current trends in palliative care in heart failure patients in real world practice are not known.
Methods: We analyzed patients in the Nationwide Inpatient Sample (NIS) between 2002-2011 with primary discharge diagnosis of heart failure. Among these patients we analyzed the co-diagnosis of palliative care. Primary outcomes of interest were yearly trends in palliative care utilization during the study period. Secondary outcomes of interest were clinical characteristics and outcomes in those undergoing palliative care.
Results: Out of 10,475,928 discharges with primary diagnosis of heart failure 88,595(0.8%)patients had co-diagnosis of palliative care. We saw a steady increase in palliative care utilization from 0.2% to 2.4% from 2002 to 2011(p<0.001)(Figure). In prior to admission variables Age, female sex, malignancy, weight loss and liver disease while during index admission acute CVD, use of vasopressors, intubation/mechanical ventilation were positive predictors of palliative care utilization. While 43.5% patients expired in-hospital, 14.2% were discharged to home hospice and 11.8% to inpatient hospice. In the overall study group with CHF there was a steady increase in discharges to Hospice (0.5% in 2002 to 3.2% in 2011, p<0.001). In-hospital mortality in heart failure patients undergoing palliative care declined from 62.5% to 35.8% from 2012 to 2011(p<0.001).
Conclusions: Our analysis showed an increasing trend in utilization of palliative care in Heart failure. During the same period there was decrease in in-hospital mortality in CHF patients undergoing palliative care possibly indicating its use beyond essentially terminal patients. Patients with multiple comorbidities and cancer were more likely to undergo palliative care.
Author Disclosures: N. Gupta: None. M. Shahreyar: None. V. Muppidi: None. N. Gaglianello: None. M.A. Papp: None. M.P. Cinquegrani: None.
- © 2014 by American Heart Association, Inc.