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.