Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample

Abstract

Background Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF. Methods and Results We conducted a retrospective cohort study in a national all‐payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years following a diagnosis of HF, and associations of time to first PCC with patient characteristics and HF‐specific clinical markers were determined. We followed 127 712 patients for a median of 792 days, of whom 18.3% received PCC in 5 years. Shorter time to receive PCC was associated with diagnoses of HF in 2016 to 2018 (compared with 2010–2015: adjusted hazard ratio [aHR], 1.421 [95% CI, 1.370–1.475]), advanced HF (aHR, 2.065 [95% CI, 1.940–2.198]), cardiogenic shock (aHR, 2.587 [95% CI, 2.414–2.773]), implantable cardioverter‐defibrillator (aHR, 5.718 [95% CI, 5.327–6.138]), and visits at academic medical centers (aHR, 1.439 [95% CI, 1.381–1.500]). Conclusions Despite an expanded definition of PC and recommendations by professional societies, PC for HF remains low in the United States. Racial and geographic variations in access and use of PC exist for patients with HF. Future studies should interrogate the mechanisms of PC underusage, especially before advanced stages, and address barriers to PC services across the health care system.