A Comparison of Hospitalized Patients With Heart Failure and Cancer Referred to Palliative Care

Key Points Question How do hospitalized patients with heart failure who are referred to palliative care differ from patients with cancer in their characteristics, reasons for referral, and outcomes of referral? Findings In this cohort study of 57 272 adults, patients with heart failure were referred for palliative care later in their disease course than patients with cancer. Fewer patients with heart failure were referred for symptom management but they had similar rates of symptom improvement after referral. Meaning Hospitalized patients with heart failure are being referred later to palliative care, suggesting that there are opportunities to integrate palliative care earlier in the disease trajectory for symptom management.
This cohort study evaluates the processes and outcomes of palliative care consultations for hospitalized patients with heart failure compared with patients with cancer at community and academic hospitals included in the Palliative Care Quality Network.
Importance Growing evidence shows that palliative care (PC) improves treatment outcomes in patients with heart failure (HF), but few large-scale studies have prospectively evaluated the processes and outcomes associated with PC consultation for such patients in the real world. Objective To characterize processes and outcomes of PC consultations for hospitalized patients with HF compared with patients with cancer. Design, Setting, and Participants This cohort study of inpatient encounters at community and academic hospitals in the Palliative Care Quality Network enrolled participants between 2013 and 2017. Of a total of 135 197 patients, 57 272 adults with a primary diagnosis of HF or cancer receiving PC consultation were enrolled. Data analysis was performed from April 2018 to December 2019. Exposures Primary diagnosis of HF or cancer. Main Outcomes and Measures Symptom improvement and changes in care planning documentation after PC consultation. Results At the time of consultation, patients with HF were older (mean age, 75.3 years [95% CI, 75.0-75.5 years] vs 65.2 years [95% CI, 65.0-65.3 years]; P