A Comparison of Hospitalized Patients With Heart Failure and
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Given the need for improved and earlier integration of palliative care (PC) in heart failure (HF) management, the purpose of this study is to compare patient characteristics, processes of care, and treatment outcomes of hospitalized patients with HF and cancer using the Palliative Care Quality Network (PCQN) data set.

Heart failure is the most common reason for hospital admission among older people. However, among PCQN hospitals, only 12.4% of referrals for specialty PC were for patients with HF, which is less than half the number of referrals received for patients with cancer. Compared with patients with cancer, patients with HF were referred later during their hospitalizations and were older, had lower functional status, and were more likely to be in higher acuity units at the time of referral. Despite these characteristics, they were also less likely to be referred to hospice at discharge compared with patients with cancer. These findings are consistent with existing literature describing delayed referral to PC and hospice services for people with HF.

Encouragingly, the hospice referral rate after PC consultation in this study was much higher than previously described hospice referral rates for hospitalized patients with HF; this may be explained by the fact that all the patients were seen by specialty PC teams with expertise in discussing hospice referral.

Current society guidelines already describe a need for early integration of PC in HF, but this study shows that this may not be happening in practice. Hospitalization is a sentinel moment in the HF disease course and may be an opportunity to get PC experts involved, especially given the high mortality rates after index hospitalization. Future studies need to explore the benefits of earlier PC integration on HF treatment outcomes, before the disease is at the end stage.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2761862