Association of Palliative Care Consultation in Patients With Heart Failure With Preserved Ejection Fraction With Symptom Burden and Health Care Use

Haider J. Warraich, MD; Sarah Godfrey, MD; Bhargav Makwana, MD; Sonu Abraham, MD; Amro Aglan, MD; Anu Mariam Saji, MD; Sumanth Khadke, MD; Rushin Patel, MD; Ashish Kumar, MD; Vahin Patel, MD; Aneri Parikh, MD; Ahan Banker, MBBS; David Venesy, MD; Sachin Shah, MD; Gary S. Winzelberg, MD, MPH; Anju Nohria, MD; Sourbha S. Dani, MD, MSc; Sarju Ganatra, MD

JACC: Advances (Jan 2025)

Association of Palliative Care Consultation in Patients With Heart Failure With Preserved Ejection Fraction With Symptom Burden and Health Care Use

Haider J. Warraich, MD,
Sarah Godfrey, MD,
Bhargav Makwana, MD,
Sonu Abraham, MD,
Amro Aglan, MD,
Anu Mariam Saji, MD,
Sumanth Khadke, MD,
Rushin Patel, MD,
Ashish Kumar, MD,
Vahin Patel, MD,
Aneri Parikh, MD,
Ahan Banker, MBBS,
David Venesy, MD,
Sachin Shah, MD,
Gary S. Winzelberg, MD, MPH,
Anju Nohria, MD,
Sourbha S. Dani, MD, MSc,
Sarju Ganatra, MD

Affiliations

Haider J. Warraich, MD: Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
Sarah Godfrey, MD: Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Bhargav Makwana, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Sonu Abraham, MD: Departmnent of Cardiovascular Medicine, McGaw Medical Center, Northwestern University, Chicago, Illinois, USA
Amro Aglan, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Anu Mariam Saji, MD: Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
Sumanth Khadke, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Rushin Patel, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Ashish Kumar, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Vahin Patel, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Aneri Parikh, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Ahan Banker, MBBS: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
David Venesy, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Sachin Shah, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Gary S. Winzelberg, MD, MPH: Division of Palliative Care and Geriatric Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Anju Nohria, MD: Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Sourbha S. Dani, MD, MSc: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
Sarju Ganatra, MD: Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA; Address for correspondence: Dr Sarju Ganatra, Vice Chair, Department of Medicine (Research), Director, Cardio-Oncology Program, Co-Director, South Asian Cardio-Metabolic Program, Landsman Heart and Vascular Center, Lahey Hospital and Medical Center, 41, Mall Road, Burlington, Massachusetts 01805, USA.

Journal volume & issue: Vol. 4, no. 1
p. 101431

Abstract

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Background: Guidelines recommend palliative care (PC) for patients with heart failure. However, little research has been performed assessing the effect of PC consultation in patients with heart failure with preserved ejection fraction (HFpEF). Objectives: The purpose of this study was to investigate the impact of PC consultation on symptom burden and health care utilization among individuals with HFpEF during the last 3 years of their lives. Methods: We retrospectively analyzed electronic medical records from 72 centers, mainly in the United States. All patients with HFpEF, identified using International Classification of Diseases codes, who died within 3 years of the diagnosis were selected and then stratified based on receipt of PC consultation. Propensity score matching was used to control for between-group differences. Results: Two hundred twenty-six thousand nine hundred twenty-one patients with HFpEF died within 3 years, only 26.4% of whom received a PC consult. In the unmatched cohort, patients who received a PC consult were more likely to be female, Black, and had more comorbidities. After propensity matching, patients receiving PC consultation were less likely to experience an emergency room visit or hospitalization (2.2% vs 4.6%), surgery or anesthesia (1.1% vs 4.2%), critical care (0.7% vs 1.9%), or receive cardiovascular procedures or tests (1.7% vs 4.7%). Furthermore, they were also less likely to have cardiorespiratory symptoms (2.5% vs 5.7%), heart failure exacerbations (1.6% vs 3.3%), cognitive symptoms (1.7% vs 3.4%), falls (0.3% vs 0.6%), and depression or anxiety (1.3% vs 2.8%). Conclusions: PC consultation is associated with reduced potential unwanted health care utilization and improvement in symptoms in patients with HFpEF in their last 3 years of life. However, PC continues to be underused in this population.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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