Trends in Palliative Care Utilization in Deceased Veterans With Heart Failure

Area of Science:

• Palliative Care
• Geriatric Medicine
• Cardiology

Background:

• Specialist-level palliative care (SPC) is crucial for managing symptoms and suffering in advanced heart failure (HF).
• Timely SPC is essential, as care provided only in the final days may be insufficient.

Purpose of the Study:

• To analyze the temporal shift in the timing of SPC initiation relative to death among Veterans with HF.
• To identify trends and potential gaps in SPC delivery for Veterans with heart failure.

Main Methods:

• Retrospective cohort study of Veterans with a heart failure diagnosis who died between 2011 and 2021.
• Analysis of the time interval from the first SPC encounter to death, examining annual cohorts.
• Primary outcome: time from SPC encounter to death.

Main Results:

• Over 56% of the cohort (n=232,079) did not receive SPC.
• SPC initiated more than 90 days before death more than doubled, from 10.1% in 2011 to 26.2% in 2021.
• Conversely, SPC in the last day of life decreased from 2.5% to 0.9%.

Conclusions:

• Specialist-level palliative care for Veterans with HF is increasingly being initiated earlier in the disease trajectory.
• There is a substantial growth opportunity to further integrate and expand SPC earlier for Veterans with heart failure.