Abstract
Background:
Heart failure hospitalizations are linked to high morbidity and mortality. Palliative care consultation may improve symptom management and quality of life yet remains underutilized.
Aim:
To evaluate recent trends in palliative care consultation and do-not-resuscitate status among heart failure hospitalizations, as well as associated outcomes.
Design:
We conducted a retrospective cohort study using the United States National Readmission Database from 2016 through 2022. Hospitalizations with a discharge diagnosis of heart failure were categorized into four groups: palliative care consultation only, do-not-resuscitate status only, both palliative care consultation and do-not-resuscitate status, or neither.
Setting/participants:
A total of 7,533,995 weighted hospitalizations with a discharge diagnosis of heart failure were identified. Of these, 281,720 (3.7%) included both palliative care consultation and do-not-resuscitate status, 124,236 (1.6%) utilized palliative care consultation only, 862,535 (11.4%) included do-not-resuscitate status only, and 6,265,504 (83.2%) included neither.
Results:
Utilization of palliative care consultation (4.7%โ5.9%) and do-not-resuscitate status (12.4%โ16.6%) increased over the study period. In unadjusted analyses, all-cause in-hospital mortality was highest in the both palliative care consultation/do-not-resuscitate status group (31%). Thirty-day unplanned readmission rate was highest in the no palliative care consultation/do-not-resuscitate status group (22.7%). Notably, 50.6% of heart failure admissions who died during hospitalization did not receive a palliative care consultation.
Conclusions:
While palliative care and do-not-resuscitate use among heart failure hospitalizations have increased, they remain low. Over half of those who die during a heart failure admission do not receive palliative care consultation, underscoring missed opportunities to optimize end-of-life care.
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