Palliative care is uncommon among heart failure patients

The use of palliative care in patients with heart failure doubled from 2007 to 2013, according to a cross-sectional analysis of Veterans Affairs external peer review program data.

However, the researchers noted that only 7.6 percent of patients received palliative care, which they deemed as low.

Lead researcher Anant Mandawat, MD, of Duke University Medical Center in Durham, North Carolina, and colleagues published their results online in JAMA Cardiology on July 6.

The analysis included 4,474 patients with heart failure who were at least 70 years old and had brain-type natriuretic peptide levels exceeding 1,000 pg/mL and creatinine levels exceeding 1.5 mg/dL.

The patients who received palliative are were similar in age, were equally likely to be male, were equally likely to have left ventricular ejection fraction of less than 35 percent and had a higher mean brain-type natriuretic peptide level compared with patients who did not receive palliative care.

Of the patients who had palliative care, 93.2 percent had hypertension within the past two years, while 45.0 percent had chronic obstructive pulmonary disease, 48.5 percent had diabetes, 29.9 percent had a cerebrovascular accident, 30.2 percent had a malignancy and 26.6 percent had an acute MI.

In addition, 51.2 percent of the overall patients died within one year of hospitalization for heart failure. The one-year mortality rates were 72.8 percent for patients receiving palliative care and 49.5 percent for patients who did not have palliative care.

Multivariable analyses found that age, year, malignancy and renal disease were significant predictors of palliative care use, according to the researchers.

They added that the study had a few limitations, including that they mostly evaluated male patients in an integrated healthcare system, so the results may not be generalizable to other populations. They also did not have information on symptoms or patient preferences.

In addition, they relied on ICD-9 codes to determine if patients had heart failure, so there could have been coding errors. However, they mentioned that the rates of palliative care among heart failure patients in this study were similar to other single-center trials.