Department of Internal Medicine, Cook County Health, Chicago, IL, USA.
Division of Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Am J Hosp Palliat Care. 2022 Mar;39(3):353-360. doi: 10.1177/10499091211021837. Epub 2021 Jun 3.
Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation.
This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014.
We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis.
We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC.
There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.
左心室辅助装置（LVAD）是心力衰竭（HF）治疗的重要组成部分，无论是作为移植前的桥梁还是作为终末期治疗手段。晚期 HF 患者预后较差，可能受益于姑息治疗咨询（PCC）。然而，关于 LVAD 植入患者接受 PCC 的趋势和预测因素的数据很少。
本研究旨在使用美国全国住院患者样本（NIS）数据库评估 2006 年至 2014 年期间 LVAD 接受者中 PCC 的发生率、趋势和预测因素。
我们对指数住院期间的 LVAD 接受者进行了加权分析。我们比较了接受 PCC 的患者和未接受 PCC 的患者。我们检查了姑息治疗利用率的趋势，并使用多变量逻辑回归分析计算调整后的优势比（aOR），以确定与 PCC 相关的人口统计学、社会和医院特征。
我们确定了 20675 例接受 LVAD 植入的入院患者，其中 4%接受了 PCC。PCC 年发生率从 0.6%增加到 7.2%（P<0.001）。DNR 状态（aOR 28.30）、女性（aOR 1.41）、转移性癌症（aOR：3.53）、中西部地区（aOR 1.33）和小医院（aOR 2.52）以及住院并发症是 PCC 的正预测因素。相反，黑人（aOR 0.43）和西班牙裔患者（aOR 0.25）接受 PCC 的可能性较小。
LVAD 入院患者住院期间 PCC 转诊呈上升趋势，而总体比例仍然较低。这些发现表明，需要建立整合模型，以便在晚期 HF 患者中尽早纳入 PCC，以增加其广泛应用。
