Palliative Care During VA Hospitalization for Heart Failure Reduces Readmissions and Mechanical Ventilation
BACKGROUND:
By 2030 the prevalence of heart failure (HF) will grow by 46%, resulting in more than 8 million adults living with HF, and an estimated $70 billion in total costs. Palliative care has become recognized as a beneficial component of HF management, particularly for symptom management and quality of life. Further understanding the association of palliative care with transitions and procedures for patients living with HF can provide important insights into the use of palliative care. This retrospective study examined the association of palliative care during HF hospitalizations with transitions (i.e., multiple readmissions or intensive care admissions) and procedures (i.e., mechanical ventilation, pacemaker implantation, or defibrillator implantation) in the six months following hospital admission. A secondary outcome was hospice use in the six months after hospital discharge. Investigators identified Veterans with HF who were admitted to VA hospitals between 2010 and 2015. From nearly 59,000 Veterans with HF admitted during this five-year period, this study cohort included 1,431 Veterans with HF who received palliative care and 1,431 Veterans with HF who did not. These cohorts were matched using data on demographics and comorbidities.
FINDINGS:
- Palliative care during hospital admissions for heart failure was associated with fewer multiple readmissions (31% versus 40%), less mechanical ventilation (3% versus 5%), and less defibrillator implantation (2% versus 4%).
- Hospice use in the six months after discharge was significantly higher among Veterans in the palliative cohort vs those in the non-palliative cohort (35% vs 18%).
IMPLICATIONS:
- These findings add to an increasing number of analyses that found associations between palliative care and positive outcomes for patients experiencing heart failure. As health systems develop population health approaches to care, palliative care for heart failure patients should be considered as an adjunct to improve patient quality of life, symptom management, and goal setting – and to potentially reduce rehospitalizations and mechanical ventilation.
LIMITATIONS:
- As with all matched cohort studies, investigators were unable to demonstrate a causal relationship.
- Study data did not comment on critical components of end-of-life care such as functional status, quality of life, and caregiver support, as these variables were not available in the medical records.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Diop, Bowen, Jiang, Wu, Cornell, Gozalo, and Rudolph (Director) are with HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans (LTSS), Providence, RI.
Diop M, Bowen G, Jiang L, Wu W-C, Cornell P, Gozalo P, and Rudolph J. Palliative Care Consultation Reduces Heart Failure Transitions: A Matched Analysis. Journal of the American Heart Association. June 2, 2020;9(11):e013989.
