Determinants of Tele-Palliative Care Utilization Among Heart Failure Patients

Abstract

Background:

The 2022 ACC/AHA/HFSA guidelines recommend the integration of palliative care (PC) in heart failure (HF) management. The potential of telemedicine to improve PC utilization among HF patients remains an area of active research. However, the factors influencing its utilization remain poorly understood.

Objective:

This study aimed to evaluate patient-level factors associated with tele-palliative care consultation (tele-PCC) utilization among HF patients admitted to a large health care system.

Methods:

A retrospective cross-sectional observational analysis was conducted on 31,055 patients admitted to University of Pittsburgh Medical Center hospitals with HF between 2017 and 2022. Multivariable logistic regression was used to identify the predictors of tele-PCC utilization, and results are expressed as odds ratios (OR) and 95% confidence intervals (CI). The accuracy of the multivariate model was assessed using the area under the curve (AUC).

Results:

Patients aged <50 (OR: 15.12; 95% CI: 7.73–29.56; p < 0.001) and those with higher Charlson Comorbidity Index scores (OR: 1.130; 95% CI: 1.05–1.22; p = 0.002) were more likely to access tele-PCC. Patients with higher Area Deprivation Index (ADI) scores (ADI <20 vs. (61–80) [OR]: 0.43; 95% CI: 0.18–0.99; p = 0.048, ADI <20 vs. >80 [OR]: 0.40; 95% CI: 0.18–0.93; p = 0.032), closer to a tertiary hospital (<20 miles: OR: 0.21; 95% CI: 0.14–0.33; p < 0.001), and those receiving care in the pre-COVID-19 era (OR: 0.06; 95% CI: 0.03–0.11; p < 0.001) were less likely to utilize tele-PCC. No significant differences were observed based on gender, insurance type, or race. The multivariate model demonstrated strong predictive ability (AUC = 0.8996).

Conclusions:

We observed greater tele-PCC utilization among younger patients and those with higher comorbidity burden and during the postpandemic era, while socioeconomic factors such as those with higher ADI continue to have limited access. These findings underscore the potential of telemedicine as a tool to enhance PC delivery to HF patients.