Racial Differences in Palliative Care Use in Heart Failure (GP146)

Outcomes 1. To understand racial differences in receipt and timing of palliative care consultations among individuals who died from heart failure.2. To consider precipitating factors for racial differences in receipt and timing of palliative care consultations among individuals who died from heart failure. Key Message Among heart failure (HF) decedents, Black individuals had greater odds of receiving a palliative care consultation (PCC) than whites. Median time from PCC to death was shorter among white than Black individuals. Findings suggest greater recognition of palliative needs among Black HF patients; however, most PCCs in HF occur late. Importance Racially minoritized individuals experience greater heart failure incidence and mortality, yet it is unclear whether there are racial disparities in receipt of palliative care in heart failure. Objective(s) We sought to assess the association between race and receipt and timing of palliative care consultation among adults who died from heart failure. Scientific Methods Utilized This retrospective cohort study used electronic medical records to identify adults who had a hospitalization at an academic health system in Georgia and died from heart failure between January 1, 2012 and December 31, 2018. Using multivariable logistic regression, we examined associations between decedent characteristics and receipt of palliative care consultation. Results Of 1,987 individuals who died with heart failure, 45.8% (n=911) received a palliative care consultation. Black individuals had 60% greater odds of receiving a palliative care consultation (OR = 1.60; 95% CI = 1.21-2.11) than white individuals. Median time from palliative care consultation to death was 38.5 days for all patients and was shorter among white than Black individuals (31.2 vs 51.5 days, p=.001). Mean age at death was younger among Black than white individuals (71.3 (14.8) vs. 81.8 (12.3) p<.001) and individuals of “other” race (71.3 (14.8) vs. 80.3 (10.4) p=.001). Relative to white individuals, Black individuals were more likely to receive inotropic therapy (42.3% vs. 54.4%, p<.001), to have a hospital admission in the last month of life (29.7% vs. 39.5%, p<.001), and have an ICU stay in the last month of life (18.3% vs. 30.3%, p<.001). Conclusion(s) Among adults who died from heart failure, a greater proportion of Black individuals received palliative care consultations compared to white individuals. Black individuals with heart failure died younger and had greater health care utilization near the end of life than whites, perhaps prompting palliative care consultations. Impact Palliative care consultations in heart failure tend to occur late for all patient groups. Efforts to integrate palliative care earlier in the heart failure trajectory are needed.