Programmatic Palliative Care Consultations in Pediatric Heart Transplant Evaluations

Area of Science:

• Pediatric Cardiology
• Palliative Care
• Health Services Research

Background:

• Guidelines recommend palliative care integration for pediatric heart failure (HF) and life-limiting conditions.
• The impact of palliative care on patient-centered outcomes in pediatric HF is not well-understood.
• Heart transplantation is a critical intervention for end-stage pediatric heart disease.

Purpose of the Study:

• To assess the association of programmatic palliative care (PPC) implementation in pediatric heart transplant evaluations.
• To evaluate PPC's impact on hospital-free days (HFD) and end-of-life (EOL) treatment choices.
• To understand how PPC influences care intensity for pediatric heart transplant candidates.

Main Methods:

• Retrospective cohort study comparing patients evaluated before and after PPC implementation.
• Included 188 pediatric patients (<19 years) undergoing heart transplant evaluation (Feb 2012-Apr 2020).
• Compared outcomes between the pre-PPC era (Feb 2012-Dec 2015) and PPC era (Jan 2016-Apr 2020).

Main Results:

• PPC was not significantly associated with increased hospital-free days (IRR 0.94).
• PPC was associated with decreased mechanical ventilation use (OR 0.12, p=0.03) at EOL.
• PPC was associated with decreased ionotropic support use (OR 0.13, p=0.03) at EOL.

Conclusions:

• Programmatic palliative care integration in pediatric heart transplant evaluations may be associated with less invasive end-of-life care.
• PPC implementation did not negatively impact hospital-free days.
• Findings suggest PPC can help align EOL care with patient and family goals in pediatric cardiology.