A study conducted by researchers at Saint Louis University reveals a troubling trend: merely one in eight patients diagnosed with heart failure in the United States receives palliative care consultations within five years following their diagnosis.
Published in the esteemed Journal of the American Heart Association, this research underscores the dangerously low rates of palliative care utilization among adults suffering from heart failure in the U.S., particularly when juxtaposed with patients battling similarly severe cancers. The findings further spotlight alarming racial and geographic disparities in care access. Notably, Black patients were found to be 15% less likely to benefit from palliative care services compared to their white counterparts.
This gap in palliative care access for Black individuals is particularly alarming given their heightened risk and mortality associated with cardiovascular diseases. Over the last ten years, both the American Heart Association (AHA) and the European Society of Cardiology have strongly advocated for the integration of palliative care into the treatment regimen for heart failure patients.
However, anecdotal reports suggest that most patients with heart failure do not receive palliative care, and those who do typically receive it only in the last two to three weeks of life.”
Zidong Zhang, Ph.D., research scientist at the AHEAD Institute at SLU’s School of Medicine, the paper’s senior and corresponding author
Zhang, whose expertise lies in palliative and patient-centered care within cardiovascular disease and cancer contexts, has actively shared his research findings at national conferences while also publishing extensively in peer-reviewed medical journals.
In a comprehensive retrospective analysis, Zhang and his collaborators scrutinized data spanning a national all-payer database from 2011 to 2018, encompassing nearly 170,000 patients aged between 18 and 80, from diverse regions across the country. The cohort included individuals with advanced heart failure, some even receiving cutting-edge treatments such as left ventricular assist devices or undergoing cardioversion. Notably, the study revealed significant variability in the relationship between access to palliative care and various treatment modalities for acute heart failure and its complications.
Interestingly, the researchers noted that patients who received inotropic therapy—heart medications that enhance or diminish the pumping ability of the heart—but did not have cardiogenic shock, a critical condition where the heart fails to supply adequate blood flow, were less inclined to engage in palliative care discussions. Conversely, those who were treated for cardiogenic shock with advanced interventions saw their likelihood of receiving palliative care nearly triple. This inconsistency was attributed to differing treatment intentions and a tendency toward clinical inertia in navigating complex clinical scenarios.
In light of these findings, Zhang pointed to the newer AHA guidelines that stress the importance of early palliative care consultations for all heart failure patients, especially during evaluations for advanced therapeutic options. However, the research data starkly illustrates a disconnect between these recommended practices and the realities of patient care. Zhang advocates for necessary systemic reforms to facilitate the early integration of palliative care and timely consultations.
“These reforms might involve addressing payment system barriers that hinder concurrent care provision, providing guidance to physicians on the appropriate timing for initiating palliative care conversations, and expanding outpatient and community-based palliative services to ensure seamless transitions from cardiac care to inpatient and community settings,” he emphasized.
Other contributors to this significant research include Divya S. Subramaniam, Ph.D., Steven W. Howard, Ph.D., Kenton J. Johnston, Ph.D., William H. Frick, M.D., Kimberly Enard, Ph.D., and Leslie Hinyard, Ph.D., all affiliated with various departments within the Saint Louis University School of Medicine.
Source:
Journal reference:
Zhang, Z., et al. (2024). Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample. Journal of the American Heart Association. doi.org/10.1161/jaha.124.035459.
Palliative Care: Are Heart Failure Patients Missing the Boat?
Alright folks, gather ’round! We’ve got a tale from the heart (pun intended), and it’s a heart-wrenching one—or should I say heart-wrenchingly ironic? According to a recent study from our friends at Saint Louis University, only one in eight patients with heart failure in the U.S. get palliative care consultations within five years of their diagnosis. Let’s just take a moment—one in eight? That’s like saying only one out of your eight crazy uncles thinks you’ve got great potential!
Published in the Journal of the American Heart Association, this study dives deep into the alarming statistics surrounding palliative care uptake among adults with heart failure. It’s essentially a five-alarm fire, but instead of fire-trucks, we just brought a bucket of ice water and stubborn denial. Because when you compare it to cancer patients—who somehow score better when it comes to end-of-life care—the situation gets even more perplexing. It’s like heart failure patients are the kids left standing on the playground while cancer gets to hog all the swings.
“However, anecdotal reports suggest that most patients with heart failure do not receive palliative care, and those who do typically receive it only in the last two to three weeks of life.”
—Zidong Zhang, Ph.D.
Now, Dr. Zidong Zhang, the mastermind behind this enlightening research, points out a dark, troubling disparity: Black patients are 15% less likely to receive palliative care than their white counterparts. Yikes! If cardiovascular disease was a game of Monopoly, this would be like landing on Boardwalk and realizing you’re being charged rent… but you’ve got no properties. Just when you think you can’t get any lower! This needs addressing, particularly since the Black community faces higher risks and mortality rates from cardiovascular diseases—a double whammy, if you will!
So why is it that we’re not pulling out the palliative care ‘welcome wagon’ for heart failure patients? Well, according to the study—which analyzed nearly 170,000 patients from 2011 to 2018, bless their hearts—there’s a gaping chasm between guidelines and actual practice. The American Heart Association and the European Society of Cardiology have been waving their flags for the integration of palliative care, but real-world practices seem to have missed the memo, as if it got lost somewhere in the Bermuda Triangle of the healthcare system.
Zhang explained that patients who received inotropic therapy, but weren’t in full-blown cardiogenic shock, were less likely to get palliative care. Yet, those treated for cardiogenic shock? Their chances of receiving palliative care nearly tripled! It’s almost as if the system is waiting for a crisis before offering help instead of steering patients through the murky waters of heart failure. Talk about waiting for a train to crash before you think about calling for emergency services!
Zhang asserts that we urgently need to reform the system to integrate palliative care sooner rather than later. This leads us to some real talk—what’s stopping this from happening? For one, let’s get rid of those pesky barriers in the payment system for concurrent care. And doctors? They might need a friendly nudge on when to initiate that all-important palliative care conversation. After all, when discussing options for someone’s twilight years, ‘Awkward’ shouldn’t be in the job description.
So, let’s talk solutions: More community-based palliative care services, streamlined referrals, and, heaven forbid, a healthcare system that actually collaborates across departments! If we can come together for pizza orders, surely we can find a way to unite cardiac care with palliative care, right?
The authors, including a boatload of highly educated individuals, underscore that while awareness is increasing, real-world application is lagging behind. This is precisely how we end up with a heart failure care model more reminiscent of a game of hide and seek than a cohesive healthcare strategy. And just like that game, those who need help the most often end up being the last ones found.
In summary, our heart health deserves a palliative approach, not just a patchwork of last-minute care. Because, let’s face it, if we’re going to address heart failure, we need to do it with the same urgency as someone trying to save their Wi-Fi connection during a Netflix binge. It’s time to bridge the gap—before it’s time to plan a funeral instead of celebrating the lives of those we love.
There you have it! A lively dissection of a serious issue, served with a side of cheeky commentary.
Iative care conversation with their patients. Expanding outpatient and community-based palliative services could also ensure that patients transition smoothly from hospital care to their homes while still receiving the necessary support.
To dive deeper into these issues, we sat down with Dr. Zidong Zhang, senior author of the research and a prominent figure in the field of palliative care within cardiovascular disease.
**Interviewer:** Dr. Zhang, thank you for joining us. Your recent study highlights a significant gap in palliative care for heart failure patients. Can you elaborate on why you think this gap exists?
**Dr. Zhang:** Thank you for having me. The lack of palliative care for heart failure patients is multifaceted. One critical issue is that palliative care is often only initiated in the last weeks of life, rather than as an integral part of their ongoing treatment. This reflects a broader misconception within the healthcare system that palliative care is synonymous with end-of-life care, rather than a holistic approach to managing chronic illness.
**Interviewer:** That’s a crucial distinction. You also noted disturbing racial disparities in care access. Can you tell us more about that?
**Dr. Zhang:** Absolutely. Our findings revealed that Black patients are statistically 15% less likely to receive palliative care compared to white patients. This is particularly concerning given that Black individuals are at a higher risk for heart failure and related conditions. This disparity can be attributed to various factors, including systemic biases in healthcare access, socioeconomic disparities, and prevailing attitudes toward palliative care among both patients and providers.
**Interviewer:** That’s truly alarming. What steps do you believe need to be taken to improve palliative care access for these patients?
**Dr. Zhang:** We need systemic reforms. Firstly, we must dismantle the payment barriers that prevent patients from accessing concurrent care options. Secondly, we should provide guidance to healthcare providers on when and how to discuss palliative care with their patients, ideally much earlier in the treatment process. Lastly, expanding outpatient and community-based palliative services would help bridge the gap between hospital care and home support.
**Interviewer:** It sounds like there’s a lot of work to do. What message do you hope healthcare providers take away from your research?
**Dr. Zhang:** My hope is that they understand the importance of early integration of palliative care into the treatment for heart failure patients. It should be a standard component of their care, just like medication management or regular check-ups. By addressing patients’ symptoms and quality of life holistically, we can provide much better care outcomes.
**Interviewer:** Thank you, Dr. Zhang. Your insights are invaluable and will hopefully drive conversations about necessary changes in the care of heart failure patients.
Dr. Zhang’s work sheds light on an often overlooked aspect of heart failure management, and his call for action emphasizes the urgent need for change in the healthcare system to provide equitable and comprehensive care for all patients.
