Association Between Palliative Care Use and In-Hospital Outcomes in Patients With Cardiogenic Shock

Area of Science:

• Cardiology
• Critical Care Medicine
• Palliative Care

Background:

• Cardiogenic shock (CS) carries a high mortality rate, even with advanced treatments like revascularization and mechanical circulatory support (MCS).
• The role of palliative care in CS management is not well-defined, with limited evidence on its impact on patient outcomes and resource use.

Purpose of the Study:

• To investigate the association between palliative care utilization and in-hospital outcomes in patients with cardiogenic shock.
• To assess the impact of palliative care on resource utilization, including mechanical circulatory support (MCS) devices, length of stay, and hospital charges.

Main Methods:

• Utilized the National Inpatient Sample database (2016-2019) to identify adult hospitalizations for cardiogenic shock.
• Stratified patients based on the receipt of palliative care and analyzed in-hospital mortality, MCS use (IABP, pVAD, ECMO), length of stay, and hospital charges.

Main Results:

• Among 574,375 CS hospitalizations, 20.1% received palliative care.
• Palliative care was associated with significantly higher in-hospital mortality (68.5% vs 26.3%) and lower overall MCS use (14.5% vs 22.7%), but higher ECMO use (3.0% vs 2.4%).
• Patients receiving palliative care experienced shorter hospital stays and incurred lower total hospital charges.

Conclusions:

• Palliative care in cardiogenic shock is associated with increased mortality, decreased MCS utilization, and reduced healthcare resource consumption.
• These findings suggest palliative care may serve as a complementary strategy in shock management, though limitations in administrative data necessitate cautious interpretation.