Racial Differences in Palliative Care Use in Heart Failure Decedents.

BACKGROUND: Minoritized individuals experience greater heart failure (HF) incidence and mortality, yet racial disparities in palliative care (PC) in HF are unknown.

METHODS: This retrospective study used electronic medical records to identify adults who were hospitalized at an academic health system and died from HF between 2012-2018. Using multivariable logistic regression, we examined associations between decedent characteristics and PC consultations (PCC).

RESULTS: Of 1,987 decedents, 45.8% (n=911) received PCCs. Black decedents had 60% greater odds of receiving PCC (OR = 1.60; 95% CI = 1.21-2.11) than Whites. Median time from PCC to death was shorter among White than Black decedents (31.2 vs 51.5 days, p=.001). Mean age at death was younger among Black versus White decedents (71.3 (14.8) vs 81.8 (12.3), p<.001) and decedents of "other" race (71.3 (14.8) vs. 80.3 (10.4), p=.001). Black decedents were more likely than Whites to receive inotropes (54.4% vs. 42.3%, p<.001), and to be admitted to the hospital (39.5% vs. 29.7%, p<.001) and ICU in their last month (30.3% vs. 18.3%, p<.001).

CONCLUSIONS: Findings suggest greater recognition of palliative needs among Black individuals with HF; however, most referrals to PC occur late in the disease trajectory.