Trends and Predictors of Palliative Care Referrals in Patients With Acute Heart Failure

To determine the rate and predictors of palliative care referral (PCR) in hospitalized patients with acute heart failure (AHF).

The PCR is commonly utilized in terminal conditions such as metastatic cancers. There is no data on trends and predictors from large-scale registry of general population regarding PCR in patients with AHF.

For this retrospective study, data were obtained from National Inpatient Sample Database from 2010 to 2014. We used International Classification of Diseases, Ninth Revision diagnosis codes to identify cases with a principle diagnosis of AHF. These patients were divided into 2 groups: (1) PCR, (2) no PCR groups. We performed multivariate analysis to identify predictors of PCRs, as well as reported PCR trends from 2010 to 2014.

From the database, out of 37 312 324 hospitalizations, 621 947 unweighted cases with primary diagnosis of AHF were selected for further analysis. About 2.8% received PCR. From 2010 to 2014, there was an uptrend from 2.0% to 3.6% for PCR. Metastatic cancer, ventilator-dependent respiratory failure, and cardiogenic shock were strongly associated with PCR. Those who underwent percutaneous coronary intervention and African American or other races were negative predictors for PCR. In the PCR group, 31.4% of patients died during hospitalization.

Palliative care referrals were made in a very small proportion of patients with AHF. We observed steady rise in the PCR utilization. Chronic conditions, advancing age, and high-risk patients were major predictors of PCR.