A recent study from Saint Louis University reveals that only 12.5% of heart failure patients in the United States receive palliative care consultations within five years of their diagnosis. This research, published in the Journal of the American Heart Association, underscores a troubling trend: the low rates of palliative care for adults with heart failure, particularly when compared to patients suffering from similar terminal illnesses like cancer.
The study also identified significant racial and geographic disparities in access to palliative care. Specifically, Black patients were found to be 15% less likely to receive these consultations compared to white patients. This is alarming given that Black individuals face higher risks and mortality rates related to cardiovascular diseases. Over the last decade, both the American Heart Association (AHA) and the European Society of Cardiology have advocated for the inclusion of palliative care in heart failure management.
Zhang, a health services researcher who focuses on palliative and patient-centered care, noted, “To our knowledge, this is the first study to investigate the uptake of palliative care consultation following a heart failure diagnosis in the general U.S. population.” Previous studies have largely concentrated on Medicare beneficiaries or veterans, making this research more comprehensive.
In their retrospective analysis, Zhang and his colleagues examined data from a national all-payer database spanning 2011 to 2018. The study included nearly 170,000 patients aged 18 to 80 from various regions across the country. Some participants had advanced heart failure or had received complex treatments such as left ventricular assist devices.
The findings revealed that patients without cardiogenic shock—an acute condition where the heart fails to pump enough blood—who received inotropic therapy were less likely to have palliative care consultations. Conversely, those treated for cardiogenic shock with advanced therapies had nearly three times higher odds of receiving palliative care. Zhang attributed this difference to treatment intentions and clinical inertia in managing complicated cases.
Zhang emphasized that the latest AHA guidelines advocate for early palliative care integration for all heart failure patients, especially during evaluations for advanced therapies. However, there remains a substantial gap between these guidelines and actual practice. He called for systemic changes to facilitate timely palliative care consultations.
“Potential reforms could include removing payment barriers for concurrent care, helping physicians determine when to start discussions about palliative care with patients, and expanding outpatient and community-based palliative services,” he suggested.
The research team also included Divya S. Subramaniam, Ph.D., Steven W. Howard, Ph.D., Kenton J. Johnston, Ph.D., William H. Frick, M.D., Kimberly Enard, Ph.D., and Leslie Hinyard, Ph.D., all affiliated with Saint Louis University School of Medicine or other institutions.
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