Abstract 4368976: Palliative Care in End-Stage Heart Failure: Impact on Readmissions, Mortality, and Healthcare Resources – A Propensity Score-Matched Analysis

Abstract

Background: Palliative care is increasingly recognized for its role in advanced heart failure management, yet its real-world impact on healthcare utilization and clinical outcomes remains underexplored. This study evaluates the association of inpatient palliative care consultation with readmission rates, hospital resource use, and mortality among patients hospitalized for end-stage heart failure (ICD code I50.84). Research Question: Is inpatient palliative care consultation for end-stage heart failure patients significantly associated with readmission rates, hospital resources, and mortality? Methods: A retrospective cohort analysis was conducted using the 2022 Nationwide Readmissions Database (NRD). Among 21,716 patients hospitalized with end-stage heart failure, 15,968 (73.5%) did not receive palliative care, while 5,748 (26.5%) did. Propensity score matching (1:1 nearest neighbor without replacement) yielded a matched cohort of 5,678 in each group. Outcomes assessed included 30-day readmission, length of stay (LOS), total hospital charges, and in-hospital mortality. Data analysis was conducted using STATA 19 (StataCorp LLC, College Station, TX). P value <0.05 was considered significant. Results: In the matched cohort, palliative care was associated with significantly lower 30-day readmission rates (3.5% vs. 6.2%, p < 0.001), representing an absolute risk reduction of 2.7% (Z = 6.32, 95% CI: 1.84%–3.59%). Median LOS was modestly longer among palliative patients (8 vs. 7 days; p < 0.0001), while median total charges were comparable ($74,747 vs. $71,391; p = 0.704). In-hospital mortality was markedly higher in the palliative group (33.1% vs. 6.8%, p < 0.001), reflecting end-of-life care decisions. Comorbidities more common in palliative patients included atrial fibrillation, chronic kidney disease, and prior myocardial infarction. Non-palliative patients had higher rates of obesity, tobacco use, and drug abuse. Conclusion: Palliative care in end-stage heart failure was associated with reduced readmissions, comparable hospital costs, and expectedly higher in-hospital mortality. These findings suggest that integrating palliative care into the management of advanced heart failure offers meaningful clinical care without compromising the hospital’s economic investments, which allows clinicians to optimize end-of-life care.