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Regional variations in palliative care: do cardiologists follow guidelines?
Dan D Matlock1, Pamela N Peterson, Brenda E Sirovich
1Department of Medicine, University of Colorado, Denver, Colorado, USA. daniel.matlock@ucdenver.edu
Journal of Palliative Medicine
|October 20, 2010
Summary
Cardiologists in high healthcare utilization regions are less likely to discuss palliative care for advanced heart failure patients, despite guidelines. This highlights a gap in end-of-life care discussions for heart failure management.
Area of Science:
- Cardiology
- Palliative Care
- Health Services Research
Background:
- Regional variations in healthcare utilization near end-of-life are significant.
- Guidelines recommend palliative care discussions for advanced heart failure patients.
Purpose of the Study:
- To investigate the association between cardiologists' palliative care discussion habits and regional healthcare use.
- To explore potential disparities in end-of-life care communication.
Main Methods:
- National mail survey of 994 cardiologists.
- Used hypothetical patient scenarios to assess physician decision-making.
- Analyzed responses from 614 cardiologists (62% response rate).
Main Results:
- Cardiologists in high-use regions were less likely to discuss palliative care for advanced heart failure patients.
- This trend was observed in both younger (75-year-old) and older (85-year-old) patient scenarios.
- Significant differences noted between highest and lowest healthcare utilization quintiles (p=0.04 and p=0.0008).
Conclusions:
- Less than half of cardiologists discussed palliative care, even in guideline-recommended scenarios.
- Guideline discordance was more pronounced in regions with higher healthcare utilization.
- Findings suggest a need to address regional disparities in palliative care communication for heart failure.
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