A nationwide retrospective analysis of trends in palliative care consultation and do-not-resuscitate status in heart failure hospitalizations.

Abstract

Heart failure hospitalizations are linked to high morbidity and mortality. Palliative care consultation may improve symptom management and quality of life yet remains underutilized. To evaluate recent trends in palliative care consultation and do-not-resuscitate status among heart failure hospitalizations, as well as associated outcomes. We conducted a retrospective cohort study using the United States National Readmission Database from 2016 through 2022. Hospitalizations with a discharge diagnosis of heart failure were categorized into four groups: palliative care consultation only, do-not-resuscitate status only, both palliative care consultation and do-not-resuscitate status, or neither. A total of 7,533,995 weighted hospitalizations with a discharge diagnosis of heart failure were identified. Of these, 281,720 (3.7%) included both palliative care consultation and do-not-resuscitate status, 124,236 (1.6%) utilized palliative care consultation only, 862,535 (11.4%) included do-not-resuscitate status only, and 6,265,504 (83.2%) included neither. Utilization of palliative care consultation (4.7%-5.9%) and do-not-resuscitate status (12.4%-16.6%) increased over the study period. In unadjusted analyses, all-cause in-hospital mortality was highest in the both palliative care consultation/do-not-resuscitate status group (31%). Thirty-day unplanned readmission rate was highest in the no palliative care consultation/do-not-resuscitate status group (22.7%). Notably, 50.6% of heart failure admissions who died during hospitalization did not receive a palliative care consultation. While palliative care and do-not-resuscitate use among heart failure hospitalizations have increased, they remain low. Over half of those who die during a heart failure admission do not receive palliative care consultation, underscoring missed opportunities to optimize end-of-life care.