Palliative Care Linked to Fewer Hospitalizations Among Veterans With Heart Failure

June 6, 2020

There could be a 46% spike in the incidence of heart failure in the United States by 2030, bringing the total to more than 8 million adults living with the condition and an approximate $69.6 billion hit to the economy.

Palliative care that veterans received during a hospitalization for heart failure was linked with a subsequent reduction in readmission for the condition, as well as less use of mechanical ventilation for treatment, according to study results appearing in the Journal of the American Heart Association.

"There is a misunderstanding about when palliative care would be beneficial, even within the medical community. There’s a perception that it’s provided only at the very end of life, and that’s not true,” said James L. Rudolph, MD, SM, study coauthor and the director of the Center of Innovation in Geriatric Services at the Providence VA Medical Center. “Palliative care added to heart failure treatment plans especially when a patient is hospitalized can have a big impact on the patient and the entire health system.”

For their retrospective propensity score matched cohort study, data on 57,182 patients were extracted from the Veterans Health Administration External Peer Review Program on hospitalizations for heart failure at 124 Veterans Affairs acute care medical centers that took place between October 2009 and September 2015. For individuals who had more than 1 such hospitalization, only the first admission (the index admission) was used for analysis.

The primary outcome was occurrence of a care transition (eg, multiple readmissions, intensive care admissions) or any procedure (eg, mechanical ventilation or pacemaker or defibrillator implantation) in the 6 months following the index admission, among the palliative care cohort (n = 1431) compared with the control cohort (n = 1431). These groups were matched by age, gender, and similar health conditions. International Classification of Disease, Ninth Revision codes were used to identify the initial palliative care encounter.

Results overwhelmingly showed that the patients with heart failure who received palliative care had 23% fewer hospitalization readmissions (more than 2; 30.9% vs 4.3%; P < . 001), 36% fewer instances of mechanical ventilation (2.8% vs 5.4%; P = .004), and 42% fewer defibrillator implantations (2.1% vs 3.6; P = .01).

This group was also older than the control cohort, with more comorbidities (eg, diabetes, lymphoma, solid tumors) and higher total hospital costs and mortality rates within 6 months of discharge (39.9% vs 37.9%). In addition, it had 90% more use of hospice in those 6 months (34.8% vs 18.3%; P < .001).

Adjustment for facility availability of palliative care for heart failure showed that consultation for the service significantly reduced the probability of multiple readmissions (adjusted HR, 0.73; 95% CI, 0.64-0.84) and the need for mechanical ventilation (adjusted HR, 0.76; 95% CI, 0.67-0.87).

“The observed association with reduced rehospitalization within 6 months among patients who received palliative care provides additional support that a palliative approach may be used to help guide goals of care conversations with patients living with heart failure,” they concluded. “As health systems develop population health approaches to delivery of care, palliative care for heart failure patients could be considered as an adjunct to improve patient quality of life, symptom management, and goal setting.”

Increasing the availability of palliative care will be key to meeting the ongoing health care needs of this ever-growing group of patients through a multidisciplinary approach, especially as it pertains to maximizing their quality of life while minimizing their suffering.

Reference

Diop MS, Bowen GS, Jiang L, et al. Palliative care consultation reduces heart failure transitions: a matched analysis. J Am Heart Assoc. Published online May 27, 2020. doi:10.1161/JAHA.119.013989