Background: In recent years, the vital role of PC in management of heart failure (HF) has been recognized. However, there is limited data on utilization of PC in the management of HF. The aim of this study is to describe the factors associated with the use of PC in HF care.
Methods: This is a retrospective analysis based on the 2014 Nationwide Inpatient Sample, the largest publicly available inpatient database in the U.S. Patients older than 18 years and concurrent chronic HF or underlying malignancy with a primary diagnosis of acute HF were included. Two analyses were performed. In the first analysis, we evaluated the odds of palliative encounters in patients with HF compared to other primary diagnoses. In the second analysis, we evaluated patient demographics, comorbidities, and hospital characteristics and their impact on PC utilization. Multivariate logistic regression was performed to test for independent associations between outcomes and variables of interest. Diagnoses were identified using ICD-9-CM codes. Analysis was performed using Stata 14.2.
Results: We identified 3,982,126 adults with comorbidities of HF or malignancy. Among these, 706,970 patients with primary diagnosis of acute HF were identified, and 25,540 patients had encounter for PC. In the first analysis, we found that patients with acute HF were less likely to utilize PC compared to others. In the second analysis, factors that were significantly associated with PC utilization were increasing age, Caucasian race, higher Charlson Comorbidity Score, income greater than $66,000, urban hospital location, and admission to a designated teaching hospital. We found no significant association with PC utilizations and acute heart HF based on gender, hospital bed size, primary insurer, or income.
Conclusion: There remains an underutilization of PC in patients with acute HF vs patients with malignancy.