Utilization of Palliative Care in Cardiogenic Shock Patients: A Retrospective Analysis of the National Inpatient Sample Database, 2020.

Background: Cardiogenic shock (CS) is one of the leading causes of death in patients with myocardial infarction, myocarditis, and congestive heart failure. The utilization patterns of specialist palliative care (PC) consultation in these patients are currently unknown. Objectives: To determine the utilization of PC in patients with CS and the overall comorbidities of that population. Methods: Review of the 2020 National Inpatient Sample identified 6,471,165 hospitalizations of which 38,531 patients were hospitalized with CS via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) code R57.0. Demographics and details of hospitalization were compared for patients who received PC evaluation (N = 8457) and those who did not (N = 30,074) as identified via ICD-10 CM code Z51.5. Results: Patients who received PC evaluation were older (≥65 years: 69.01% vs. 55.04%, p < 0.001), had shorter hospital stays (<14 days: 78.92% vs. 70.35% patients, p < 0.001), and higher in-hospital mortality (65.80% vs. 24.23%, p < 0.001) with higher Charlson Comorbidity Index (≥4, 55.22% vs. 48.09%, p < 0.001). Furthermore, the patients who received PC had significantly higher odds of death than those who did not (adjusted odds ratio = 6, p < 0.0001). Conclusion: Despite high mortality rates, specialist PC is not routinely involved in the care of those who die with CS, although does appear to be utilized among those most likely to die. This suggests preferential utilization of specialist PC for terminal patients; however, further research will be helpful to better understand current consult practices and increase PC utilization for this highly morbid population.