In the Journals

Palliative care may be underutilized for MI despite increase in recent years

Islam Y. Elgendy

The use of palliative care was low for patients hospitalized for acute MI, but the rate of use increased between 2002 and 2016, according to a study published in the Journal of the American College of Cardiology.

“Our findings suggest that palliative care is underutilized in patients with acute MI,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “It is reassuring to see that there has been an increase in palliative care utilization for patients with acute MI during the study period, suggesting that there is increasing awareness among treating physicians.”

National Inpatient Sample data

Researchers analyzed data from 9,443,587 hospitalizations for acute MI from the National Inpatient Sample 2002 to 2016 database. STEMI (n = 3,420,479) and NSTEMI (n = 6,043,519) were included in the study.

The main outcomes of interest were factors and temporal trends linked to palliative care use, and secondary outcomes included in-hospital mortality and invasive procedures such as mechanical circulatory support devices and PCI.

Of the hospitalizations in the study, 1.3% had a palliative care encounter.

Palliative care penetration increased from 0.2% in 2002 to 3% in 2016 (P for trend < .001). This increase was seen in both patients with STEMI (0.2% to 3.9%; P for trend < .001) and NSTEMI (0.1% to 2.7%; P for trend < .001), in addition to those who died during hospitalization (1.5% to 31.6%; P for trend < .001) and survived hospitalization (0.05% to 1.6%; P for trend < .001).

In-hospital mortality rates in patients who received palliative care decreased from 72.5% in 2002 to 50.1% in 2016 (P for trend < .001). This rate also increased in patients with cardiogenic shock (85.9% to 77.5%; P for trend = .03).

Several patient-related characteristics were positively linked to palliative care use, including female sex, older age, do-not-resuscitate status, white race and comorbidities such as HF, chronic pulmonary disease, valvular heart disease and cardiogenic shock.

Patients who received palliative care were less likely to receive systemic thrombolysis (0.8% vs. 1.6%; P < .001) or PCI (16.3% vs. 42.4%; P < .001) compared with those who did not receive palliative care. These patients were more likely to undergo mechanical ventilation (35.1% vs. 8%; P < .001) and receive a percutaneous ventricular assist device (1.3% vs. 0.2%; P < .001) and an intra-aortic balloon pump (8.7% vs. 4.6%; P < .001). Higher rates of in-hospital mortality were observed in patients who received a palliative care encounter (53.7% vs. 5.2%; P < .001).

‘Underutilized service’

“Palliative care is an underutilized service in cardiology,” Elgendy said in an interview. “Several reasons may explain this, like some physicians are not familiar with this service or only believe that this service is offered when the patient is terminally ill. Other reasons include that some hospitals might not have access to palliative care services.” – by Darlene Dobkowski

For more information:

Islam Y. Elgendy, MD, can be reached at 55 Fruit St., GRB-800, Boston, MA 02114; email: iyelgendy@gmail.com; Twitter: @islamelgendy83.

Disclosures: Elgendy reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Islam Y. Elgendy

The use of palliative care was low for patients hospitalized for acute MI, but the rate of use increased between 2002 and 2016, according to a study published in the Journal of the American College of Cardiology.

“Our findings suggest that palliative care is underutilized in patients with acute MI,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “It is reassuring to see that there has been an increase in palliative care utilization for patients with acute MI during the study period, suggesting that there is increasing awareness among treating physicians.”

National Inpatient Sample data

Researchers analyzed data from 9,443,587 hospitalizations for acute MI from the National Inpatient Sample 2002 to 2016 database. STEMI (n = 3,420,479) and NSTEMI (n = 6,043,519) were included in the study.

The main outcomes of interest were factors and temporal trends linked to palliative care use, and secondary outcomes included in-hospital mortality and invasive procedures such as mechanical circulatory support devices and PCI.

Of the hospitalizations in the study, 1.3% had a palliative care encounter.

Palliative care penetration increased from 0.2% in 2002 to 3% in 2016 (P for trend < .001). This increase was seen in both patients with STEMI (0.2% to 3.9%; P for trend < .001) and NSTEMI (0.1% to 2.7%; P for trend < .001), in addition to those who died during hospitalization (1.5% to 31.6%; P for trend < .001) and survived hospitalization (0.05% to 1.6%; P for trend < .001).

In-hospital mortality rates in patients who received palliative care decreased from 72.5% in 2002 to 50.1% in 2016 (P for trend < .001). This rate also increased in patients with cardiogenic shock (85.9% to 77.5%; P for trend = .03).

Several patient-related characteristics were positively linked to palliative care use, including female sex, older age, do-not-resuscitate status, white race and comorbidities such as HF, chronic pulmonary disease, valvular heart disease and cardiogenic shock.

Patients who received palliative care were less likely to receive systemic thrombolysis (0.8% vs. 1.6%; P < .001) or PCI (16.3% vs. 42.4%; P < .001) compared with those who did not receive palliative care. These patients were more likely to undergo mechanical ventilation (35.1% vs. 8%; P < .001) and receive a percutaneous ventricular assist device (1.3% vs. 0.2%; P < .001) and an intra-aortic balloon pump (8.7% vs. 4.6%; P < .001). Higher rates of in-hospital mortality were observed in patients who received a palliative care encounter (53.7% vs. 5.2%; P < .001).

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‘Underutilized service’

“Palliative care is an underutilized service in cardiology,” Elgendy said in an interview. “Several reasons may explain this, like some physicians are not familiar with this service or only believe that this service is offered when the patient is terminally ill. Other reasons include that some hospitals might not have access to palliative care services.” – by Darlene Dobkowski

For more information:

Islam Y. Elgendy, MD, can be reached at 55 Fruit St., GRB-800, Boston, MA 02114; email: iyelgendy@gmail.com; Twitter: @islamelgendy83.

Disclosures: Elgendy reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.