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Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation

Background: Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. Aim: To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Design: Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Setting/Participants: Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Results: Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 (P < .01). In comparison, rate of palliative care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 (P < .01). In a multivariate logistic regression model, higher socioeconomic status (SES) was associated with increased access to palliative care (P < .01). Racial differences were also observed in rates of referral to palliative care. Conclusion: The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.