Trends and Disparities in Palliative Care Encounters in Acute Heart Failure Admissions; Insight From National Inpatient Sample

Heart failure is a leading cause of readmissions in the United States, although treatment has come along away, palliative care is often not appropriately offered in advanced heart failure. The purpose of this study was to use a large database of national in-patient sample to find out the use of palliative care in acute heart failure admissions. Data from 2002 to 2017 was used for analysis. Simple linear regression was used for trend analysis over the years. Variables that were statistically significant in univariate analysis were used in single-step (entry method) multiple logistic analysis. The use of palliative care was found to be low at 4.1%, although recent trends have shown an increase (from 0.4% in 2002 to 6.2% in 2017). Women (0.3% in 2002 to 6.5% in 2017) and Caucasians (0.6% in 2002 to 6.9% in 2017) had a higher proportion of PC encounters as compared to men (0.5% in 2002 to 5.9% in 2017) and other racial minorities, increasing age (OR, 1.04[CI; 1.03-1.04], p < 0.01), female gender (OR, 1.03[CI; 1.02-1.03], p < 0.01), do not resuscitate status (OR, 10.62[CI; 10.53-10.70], p < 0.01), diabetes mellitus (OR, 1.10[CI; 1.01-1.11], p < 0.01), liver disease (OR, 1.63[CI; 1.60-1.66], p < 0.01), renal failure (OR, 1.40[CI; 1.39-1.41], p < 0.01), acute myocardial infarction (OR, 1.28[CI; 1.27-1.30], p < 0.01), and cardiogenic shock (OR, 2.89[CI; 2.84-2.93], p < 0.01) were associated with higher odds of having PC encounter. In conclusion, the use of palliative care has increased in the United States over the years, however, it is still low as compared to other high-income countries.