Racial and Ethnic Disparities in Palliative and Hospice Care Utilisation in Heart Failure: A Systematic Review and...

IntroductionStudies have explored racial and ethnic disparities in palliative (PC) and hospice care (HC) utilisation among patients with heart failure (HF), with inconsistent findings. However, these data have not been systematically synthesised.MethodsWe conducted a systematic review and meta-analysis of studies exploring racial and ethnic differences in utilisation of PC or HC in HF. PubMed, EMBASE, Scopus and CINAHL were searched until February 26th, 2026 (PROSPERO ID: CRD42061320684). The primary outcome was odds of receiving PC or HC, derived from adjusted odds ratios (aOR). Unadjusted odds ratios were pooled as secondary analyses. Prespecified subgroup analyses were performed according to study location, care type and HF population.ResultsTwenty-four studies were identified, of which twenty-one (n = 18,284,043 patient-level observations) were included in meta-analyses. Compared with White patients, lower adjusted odds of palliative or hospice care utilisation were observed among Black, Hispanic, Asian and Other racial or ethnic groups, although heterogeneity was substantial for several comparisons: Black (aOR 0.79, 95% CI 0.65-0.96; I² = 99%), Hispanic (aOR 0.69, 95% CI 0.60-0.79; I² = 94.0%), Asian (aOR 0.80, 95% CI 0.73-0.88; I² = 0%) and other ethnic groups (aOR 0.81, 95% CI 0.67-0.99; I² = 60.4%). Unadjusted outcomes were broadly similar. Subgroup analyses demonstrated variation in findings for Black vs White patients according to study characteristics.DiscussionThere appears to be lower documented palliative and hospice care utilisation among several racial and ethnic minority groups compared with White patients, although the magnitude and direction of associations varied by study design, population, care type and setting.