Abstract 13526: Palliative Care Service Utilization in End-Stage Heart Failure: A Propensity Matched Nationwide Analysis

Abstract

Background: Palliative care services (PCS) is crucial in the care of end-stage heart failure (ESHF) patients. However, there is limited data on the utilization rates and the predictors PCS in ESHF patients. Research question: What is the frequency of PCS utilization, and what are the predictors of PCS use in ESHF patients? Methods: ESHF admissions were identified from the National Inpatient Sample database from 2018 – 2020. The identified admissions were stratified based on the use of PCS. The primary outcomes were the rate of utilization, and the predictors of PCS use in ESHF patients. Multivariate logistic regression and propensity matching were used to adjust for confounders. Results: In total, 147,140 ESHF admissions were identified, of which only 6.2% (9170) had PCS use. Patients with PCS were older(71.66 years vs 63.78 years; p<0.001), and were less likely to be of African American race (13.7% vs 17%; p<0.001). They were more likely to have a do-not-resuscitate (DNR) status (66.1% vs 10.2%; p<0.001), be frail (42.4% vs 18.3%), and have had a cardiac arrest event(2.5% vs 0.8%;p<0.001). The major predictors of PCS use were DNR status (adjusted odds ratio[aOR]:13.38, 95%CI: 11.73 – 15.27; p<0.001), cardiogenic shock (aOR: 3.54, 95%CI: 3.02 – 4.15; p<0.001), cardiac arrest during the current admission (aOR: 1.57, 95%CI: 1.01 – 2.44; p<0.001), & urban teaching hospital status (aOR: 1.69, 95%CI: 1.36 – 2.09; p<0.001) Fig 1 . A matched pair of 8255 patients were identified in both groups. The ESHF patients with PCS had a higher in-hospital mortality (aOR: 3.30; 95%CI: 2.73 – 3.99; p<0.001), and were less likely to receive a heart transplant (aOR: 0.25; 95%CI: 0.12 – 0.50; p<0.001) Tab 1. Conclusion: Palliative care services are significant underutilized in the United States. DNR status, cardiogenic shock, respiratory failure, cardiac arrest, and admission to an urban teaching hospital were the major predictors of PCS use in ESHF.