Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-Day Readmission

Abstract

Background: Patients admitted with cardiogenic shock (CS) have high mortality rates, readmission rates, and healthcare costs. Palliative care services (PCS) may be underused, and the association with 30-day readmission and other predictive factors is unknown. We studied the frequency, etiologies, and predictors of 30-day readmission in CS admissions with and without PCS in the United States.

Methods and results: Using the 2017 Nationwide Readmissions Database, we identified admissions for (1) CS, (2) CS with PCS, and (3) CS without PCS. We compared differences in outcomes and predictors of readmission using multivariable logistic regression analysis accounting for survey design. Of 133,738 CS admissions nationally in 2017, 36.3% died inpatient. Among those who survived, 8.6% used PCS and 21% were readmitted within 30 days. Difference between CS with and without PCS groups included mortality (72.8% vs 27%), readmission rate (11.6% vs 21.9%), most frequent discharge destination (50.2% skilled nursing facilities vs 36.4% home), hospitalization cost per patient ($51,083 ± $2,629 vs $66,815 ± $1,729). The primary readmission diagnoses for both groups were heart failure (32.1% vs 24.4%). PCS use was associated with lower rates of readmission (odds ratio, 0.462; 95% confidence interval, 0.408-0.524; P < .001). Do-not-resuscitate status, private pay, self-pay, and cardiac arrest were negative predictors, and multiple comorbidities was a positive predictor of readmission.

Conclusions: The use of PCS in CS admissions remains low at 8.6% in 2017. PCS use was associated with lower 30-day readmission rates and hospitalization costs. PCS are associated with a decrease in future acute care service use for critically ill cardiac patients but underused for high-risk cardiac patients.

Keywords: Cardiogenic shock; health services and outcomes; palliative care services; readmission.

Fig. 1.

Cohort population flow chart diagram (survey weighted).

Fig. 2.

Cumulative rate of first readmission among index population, stratified by palliative care services (PCS) vs non-PCS. *Cohort not limited to those readmitted within 30 days only.

Fig. 3.

Primary diagnoses for 30-day readmission in patients with cardiogenic shock (CS) with and without PCS (survey weighted). CIR, cardiovascular/circulatory; ENDO, endocrine, nutritional and metabolic; GI, digestive/gastroenterology; GU, genitourinary; HEM, hematologic; ID, infectious diseases; INJ, injury and poisoning; NEURO, nervous system; PCS, palliative care services; PULM, respiratory; SYM, symptoms, signs and abnormal clinical and laboratory findings; OTHER, includes dermatologic, mental/behavioral, neoplasms musculoskeletal, and ophthalmologic diseases.