Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Heart Association, 13(17), e035459. https://doi.org/10.1161/JAHA.124.035459 Dr. Zidong Zhang et al.
Points
- A study of 127,712 U.S. adults with heart failure (HF) found that only 18.3% received a palliative care consultation (PCC) within five years of diagnosis.
- Patients diagnosed with HF more recently (2016-2018) were significantly more likely to receive timely PCCs than those diagnosed earlier, reflecting access improvements.
- Advanced HF diagnosis, cardiogenic shock, implantable cardioverter-defibrillators, and treatment at academic centers were strong predictors of earlier PCC.
- Despite benefits, palliative care remains underutilized among HF patients, with racial and geographic disparities in access to these services.
- The study calls for further research into the barriers causing low palliative care usage and disparities, aiming to improve timely access for HF patients.
Summary
This research paper investigates the national use of palliative care (PC) among adults with heart failure (HF) in the United States, focusing on the timing of their first palliative care consultation (PCC) following an HF diagnosis. Conducting a retrospective cohort study utilizing a national all-payer electronic health record database, the authors identified 127,712 adults aged 18 years and older diagnosed with HF between 2011 and 2018. They found that only 18.3% of these patients received a PCC within five years of diagnosis. The study aimed to explore the associations between the timing of the first PCC and various clinical factors specific to HF.
The analysis revealed that shorter time intervals to receiving PCC were significantly associated with several clinical characteristics. Specifically, patients diagnosed with HF between 2016 and 2018 were 42.1% more likely to receive timely consultations compared to those diagnosed from 2010 to 2015 (adjusted hazard ratio [aHR], 1.421; 95% confidence interval [CI], 1.370–1.475). Additionally, advanced HF diagnosis (aHR, 2.065; 95% CI, 1.940–2.198) and cardiogenic shock (aHR, 2.587; 95% CI, 2.414–2.773) were strong predictors of earlier PCC. Other factors associated with a shorter time to PCC included having an implantable cardioverter-defibrillator (aHR, 5.718; 95% CI, 5.327–6.138) and receiving care at academic medical centers (aHR, 1.439; 95% CI, 1.381–1.500).
Despite the recognized benefits of palliative care for HF patients, the study highlights a persistent low utilization of these services across the United States. Notable racial and geographic disparities in access to PC were identified, underscoring the need for future research to investigate the underlying mechanisms of underutilization and to address barriers that prevent timely access to palliative care services within the healthcare system.
Link to the article: https://www.ahajournals.org/doi/10.1161/JAHA.124.035459
References Zhang, Z., Subramaniam, D. S., Howard, S. W., Johnston, K. J., Frick, W. H., Enard, K., & Hinyard, L. (2024). Use of palliative care among adults with newly diagnosed heart failure: Insights from a us national insured patient sample. Journal of the American Heart Association, 13(17), e035459. https://doi.org/10.1161/JAHA.124.035459
