Association Between Palliative Care Use and In-Hospital Outcomes in Patients With Cardiogenic Shock

Abstract

Objective

Cardiogenic shock is associated with high mortality despite advances in revascularization and mechanical circulatory support (MCS). While palliative care may play a role in guiding treatment decisions, the available evidence is limited. This study aimed to assess the association between the use of palliative care and in-hospital outcomes, as well as resource utilization, in patients experiencing cardiogenic shock.

Methods

Using the National Inpatient Sample database (2016–2019), we identified adults hospitalized with cardiogenic shock. Patients were stratified according to receipt of palliative care. Outcomes included in-hospital mortality, use of MCS, intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), extracorporeal membrane oxygenation (ECMO), length of stay, and hospital charges.

Results

Among 574,375 hospitalizations with cardiogenic shock, 20.1% involved palliative care. In-hospital mortality was significantly higher with palliative care (68.5% vs 26.3%; adjusted relative risk [RR] 2.51; 95% confidence interval [CI] 2.47–2.54). Palliative care was associated with lower use of MCS overall (14.5% vs 22.7%; adjusted RR 0.69; 95% CI 0.67–0.72), including IABP and pVAD, but higher use of ECMO (3.0% vs 2.4%; adjusted RR 1.47; 95% CI 1.34–1.60). Patients receiving palliative care had shorter hospital stays and lower total charges. Findings were consistent across ischemic and nonischemic groups.

Conclusions

In cardiogenic shock, palliative care was associated with higher mortality, lower MCS use, and reduced healthcare utilization. These findings support its role as a complementary component of shock management. However, interpretation remains limited by the restricted clinical detail of administrative data, including absent information on illness severity, treatment trajectory, and the precise timing or nature of palliative care involvement.