Palliative care may reduce readmissions, mechanical ventilation for HF
Veterans who received palliative care during HF admissions had less mechanical ventilation and fewer readmissions compared with those who did not, according to findings in the Journal of the American Heart Association.
“The findings expand the understanding of concurrent care’s benefits to patients with heart failure,” James L. Rudolph, MD, SM, director of the Center of Innovation in Geriatric Services at Providence VA Medical Center, professor of medicine at Brown University Warren Alpert Medical School and professor of health services, policy and practice at Brown University School of Public Health, told Healio. “Palliative care improves quality of life, and this is based on the veteran’s choices. ... If a patient is struggling with advanced heart failure, palliative care can have benefits without limiting choices for treatments.”
For the retrospective, propensity-score matched cohort study, Michelle S. Diop, MD, who was a medical student at Brown University Warren Alpert Medical School during the study and is now a resident physician at Massachusetts General Hospital, and colleagues analyzed data from 57,182 patients (mean age, 71 years; 98% men) who were hospitalized for HF from 2010 to 2015 at one of 124 Veterans Affairs Medical Center acute care hospitals. Patients who received palliative care during HF hospitalization (n = 1,431; mean age, 76 years; 99% men) were propensity matched to those who did not receive the care (n = 1,431; mean age, 76 years; 99% men).
“Currently, much of the U.S. only has the option for hospice care or regular care for HF. This is due to the reimbursement structure of hospice,” Rudolph said in an interview. “The VA has palliative care services available at each of the 150 VA medical centers throughout the U.S. The goal of palliative care is to improve quality of life.”
The primary outcome was procedures and transitions 6 months after hospital discharge. Transitions included multiple intensive care admissions or readmissions, in addition to procedures such as pacemaker implantation, mechanical ventilation or defibrillation implantation.
Compared with those who did not receive palliative care, those who did had fewer multiple hospitalizations (30.9% vs. 40.3%; P < .001), defibrillator implantation (2.1% vs. 3.6%; P = .01) and mechanical ventilation (2.8% vs. 5.4%; P = .004).
Patients who received consultation for palliative care were less likely to have mechanical ventilation (adjusted HR = 0.76; 95% CI, 0.67-0.87) and multiple readmissions (aHR = 0.73; 95% CI, 0.64-0.84) compared with those who did not receive consultation after adjusting for facility fixed effects.
“Palliative care is developing as a specialty,” Rudolph told Healio. “The development of the specialty leads to the opportunity to expand these findings to other life-limiting conditions such as dialysis and advanced lung disease.” – by Darlene Dobkowski
For more information:
James L. Rudolph, MD, SM, can be reached at james.rudolph@va.gov.
Disclosures: The authors report no relevant financial disclosures.
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