Palliative Care in Acute Cardiovascular Hospitalizations: A National Inpatient Sample Analysis.

Abstract

Palliative care (PC) is increasingly recognized as important in caring for patients with cardiovascular disease (CVD); however, gaps remain in its utilization during acute CVD hospitalizations. To identify demographic, clinical, and institutional predictors of PC utilization during acute CVD hospitalizations. Using data from the 2016-2019 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, we analyzed factors associated with PC interventions in hospitalizations with acute CVD as the primary diagnosis. PC intervention was identified using ICD-10-CM code Z51.5. Multivariate logistic regression and two-factor ANOVAs were employed to examine associations between PC utilization and patient and hospital characteristics. Among 823,232 acute CVD hospitalizations, 3.9% involved PC. PC recipients were more likely to be older, female, White or Asian, Medicare-insured, and from higher-income ZIP codes (p < .001). Medicaid and self-pay patients were significantly underrepresented. Larger hospitals, those located in suburban and city areas, with the exception of center city hospitals, and teaching hospitals had higher PC rates. Across diagnoses, cardiogenic shock had the highest PC utilization (25.4%). PC was associated with decreased procedure burden, however, length of stay, hospital charges, and in-hospital mortality were higher among PC recipients, reflecting referral of patients with greater illness severity. PC utilization in acute CVD hospitalizations is strongly predicted by specific sociodemographic and institutional factors rather than clinical impact alone. Interventions to equitably increase referral rates should target both patient-level predictors and hospital-level practice patterns.