Abstract 14583: Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-day Readmission

Abstract

Introduction: Patients admitted with cardiogenic shock (CS) have high in-patient mortality and readmission rates. Palliative care services (PCS) may be underutilized in this population and the association with 30-day readmission and other predictive factors are unknown. Methods: Using the 2017 Healthcare Cost and Utilization Project’s National Readmission Database, we identified index admissions in patients with (1) CS (ICD-10-CM code R57.0) and (2) CS with PCS (ICD-10-CM code Z51.5). Patients with orthotopic heart transplant or left ventricular assist device were excluded. We compared differences in 30-day readmission outcomes and identified readmission predictors using logistic regression analysis. Results: Among 127,045 survey-weighted CS index admissions, inpatient mortality was 37.0%. In those survived (n=80,030), 21.0% (n=16,779) were readmitted within 30 days and 12.3% (n=9,841) had DNR orders (ICD-10-CM code Z66). Of 26,555 CS with PCS index admissions, 72.5% died inpatient. In those survived (n=7,285), 11.6% (n=844) were readmitted within 30 days and 61.2% (n=4,461) had DNR orders. From CS with PCS index admissions, mean age was 70.7; 39.2% were female; 50.0% discharged to skilled nursing facility and 33.9% discharged to home health care. The average time to readmission was 11.8 days with 36% of all readmissions within first 14 days. Primary causes of readmission were cardiac (47.7%) and infectious (13.7%). Predictors of 30-day readmission for CS group versus CS with PCS group are listed in table. Conclusions: Use of PCS in patient admitted with CS remains low at 8.6% in 2017. PCS and DNR orders were associated with lower risk of 30-day readmission. Those receiving PCS during index admission had lower readmission rates at 11.6%. In CS with PCS index admissions, cardiopulmonary and renal diseases were positive predictors while female gender, private insurance, private hospital and higher household income were negative predictors of 30-day readmission.