Palliative care referral among patients hospitalized with advanced heart failure

BACKGROUND: Many heart failure (HF) patients experience high symptom burden, but palliative care (PC) services have been used infrequently in this population.

OBJECTIVE: The specific aim of this study was to identify individual-level factors associated with PC referral.

METHODS: The study sample included adult patients hospitalized at an academic medical center with a primary diagnosis of HF between January 2005 and June 2010. Inpatient records were merged with the PC database to identify HF patients who received PC consultations. The analytical sample included 2647 HF admissions. We used descriptive statistics to characterize HF patients who received and did not receive PC services. Logistic regression analyses were used to identify patient characteristics that predict PC referral.

RESULTS: Just over 6% of patients with HF were referred to PC during their hospitalization. We identified the following statistically significant determinants of PC referral: secondary diagnosis of Alzheimer's disease, receipt of thoracentesis, intensive care unit (ICU) stay, and prior HF-related hospitalizations.

CONCLUSIONS: Currently, only a fraction of HF patients who are at high risk for morbidity and mortality receive PC services. Additional research is needed to identify factors associated with PC referral that can be prospectively identified, and to develop better prediction models to identify HF patients who may benefit from PC referral.