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Characteristics and Outcomes of Palliative Continuous Intravenous Inotrope Support Among Medicare Beneficiaries With
Sarah Chuzi1, Jing Gao2, Joshua Thariath2
1Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.
Insights
Continuous intravenous inotropic support (CIIS) for advanced heart failure (HF) is uncommon in Medicare patients. Palliative CIIS use is associated with high hospital admissions and low palliative care utilization, indicating a need for better integration of services.
Area of Science:
- Cardiology
- Palliative Care
- Health Services Research
Background:
- Continuous intravenous inotropic support (CIIS) can alleviate symptoms in stage D heart failure (HF).
- Limited data exists on the characteristics and outcomes of patients receiving CIIS as palliative therapy.
- Understanding palliative CIIS use is crucial for improving end-of-life care in HF patients.
Purpose of the Study:
- To describe the characteristics of Medicare beneficiaries receiving CIIS as palliative therapy.
- To evaluate the outcomes, including admission, death, and palliative/hospice care utilization, within one year of initiating palliative CIIS.
- To identify gaps in palliative care integration for patients on CIIS.
Main Methods:
- Retrospective analysis of Medicare fee-for-service (FFS) beneficiaries with HF diagnostic codes (2016-2017).
- Inclusion criteria: initiation of CIIS between 2016-2017, excluding prior advanced HF therapies or CIIS.
- Primary outcomes: all-cause admission, death, palliative care, and hospice utilization within one year post-CIIS initiation.
Main Results:
- 3,706 (0.3%) of 1,463,942 HF beneficiaries initiated palliative CIIS.
- Users were older (average age 78), predominantly male (58.9%), White (82.1%), and had high comorbidity (Charlson score 5.8).
- Within one year: 72.2% had ≥1 admission, 38% died, and only 6.5% had palliative care codes, while 18% had hospice claims.
Conclusions:
- Palliative CIIS is infrequently used among Medicare FFS beneficiaries, primarily for older individuals with significant comorbidities.
- High rates of hospitalization and low utilization of palliative care services were observed despite the palliative intent of CIIS.
- Enhanced integration of palliative care services is essential for patients receiving CIIS for advanced heart failure.
Background:
Continuous intravenous inotropic support (CIIS) can improve symptoms and functional status for patients with stage D heart failure (HF), but characteristics and outcomes of large cohorts treated with CIIS as a palliative therapy have not been described.
Methods And Results:
We identified Medicare fee-for-service (FFS) beneficiaries with diagnostic codes for HF in 2016 to 2017. After excluding beneficiaries who received advanced HF surgical therapies 2014 to 2018 and prior CIIS, we included remaining beneficiaries who initiated CIIS from 2016 to 2017. Primary outcomes were rates of admission, death, palliative care, and hospice utilization within 1 year of CIIS initiation. We identified 1 463 942 Medicare beneficiaries with HF in 2016 to 2017, of whom 3706 (0.3%) beneficiaries initiated palliative CIIS (58.9% male, 82.1% White, 67.1% from urban areas, average age 78 [SD=6.8] years). Average Charlson Comorbidity Index Score was 5.8 (SD=3.1). Only 6.5% of CIIS users had a diagnostic code suggesting receipt of palliative care services. Within 1 year of CIIS initiation, 72.2% of beneficiaries had at least 1 all-cause admission, 55.7% had ≥2 admissions, and 38% had died. Almost 18% of CIIS users had a claim for hospice services; of CIIS users who died, 43.3% had a hospice claim.
Conclusions:
Among Medicare FFS beneficiaries with HF, palliative CIIS is rare and primarily utilized among older beneficiaries with high global comorbidity. Despite the palliative indication, beneficiaries have high rates of admission and low use of palliative care services. Palliative care and associated services should be better integrated into the care of patients with palliative CIIS.
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