{
  "abstract": "Background Patients with chronic obstructive pulmonary disease (COPD) and end-stage heart failure (ESHF) represent a population group with a significant symptom burden, affected quality of life, and limited life expectancy. Although palliative care(PalC) is recommended in advanced heart and pulmonary disease, its real-world application in patients with coexisting ESHF and COPD is not well described.Methods We analyzed adult hospitalizations in the National Inpatient Sample (2018–2022) with concurrent diagnoses of ESHF and COPD. Patients were stratified by receipt of PalC. Trends in PalC use and in-hospital mortality were assessed. Multivariable logistic regressions identified independent predictors of PalC utilization.Results Of 48,055 admissions, 13,380 (27.8%) involved PalC. Use of PalC did not significantly change from 2018 to 2022 (27.3% vs 29.6%, p=0.15). In-hospital mortality remained stable over time among both PalC recipients (27.9%; p-trend = 0.87) and non-PalC patients (6.9%; p-trend = 0.47). Independent variables associated with higher odds of palliative care (PalC) utilization included older age(mean age: 72.98 vs. 68.14 years, p<0.001)(aOR 1.033 per year, p<0.001), private insurance compared with Medicare (aOR 1.311, p=0.001), treatment at urban non-teaching hospitals (aOR 1.542, p<0.001) and urban teaching hospitals (aOR 1.536, p<0.001) compared with rural hospitals, and admission to medium-bed (aOR 1.275, p=0.004) and large-bed hospitals (aOR 1.321, p<0.001) compared with small hospitals. Hospitalization in the Midwest vs. the Northeast was also associated with increased PalC use (aOR 1.297, p=0.002). Among clinical factors, cirrhosis (aOR 1.337, p=0.007), cachexia (aOR 1.608, p<0.001), suicidal ideation (aOR 1.852, p=0.037), and underlying malignancy (aOR 1.391, p=0.004) were independently associated with higher odds of PalC utilization. Conversely, lower odds of PalC use were observed among patients with a heart assist device (aOR 0.168, p<0.001), LVAD procedure during hospitalization (aOR 0.204, p<0.001), peripheral vascular disease (aOR 0.875, p=0.013), obesity (aOR 0.776, p<0.001), alcohol abuse (aOR 0.795, p=0.044), history of coronary artery bypass grafting (CABG) (aOR 0.826, p=0.011), dyslipidemia (aOR 0.854, p=0.002), or hypertension (aOR 0.745, p<0.001). In addition, Black (aOR 0.773, p<0.001) and Hispanic patients (aOR 0.678, p=0.001) were significantly less likely to receive PalC compared with White patients. The mean length of stay was significantly shorter in the PalC group (8.42 vs. 9.05 days, p=0.0079), with lower total charges ($109,640 vs. $149,265, p<0.001).Conclusion PalC utilization in patients with concurrent COPD and ESHF remains low and has not significantly increased over the past 5 years. Disparities by race, insurance, and comorbidity burden highlight the need for targeted education, system-level interventions, and equitable access to palliative care in high-risk cardiopulmonary populations.",
  "authors": [
    {
      "affiliations": [
        "Trinity Health Oakland, Oakland, Michigan, United States"
      ],
      "name": "Parjanya Bhatt"
    },
    {
      "affiliations": [
        "Alexandra Hospital, Redditch, United Kingdom"
      ],
      "name": "Mohsin Nawaz"
    },
    {
      "affiliations": [
        "James Cook University Hospital, Middlesbrough, United Kingdom"
      ],
      "name": "Mohamed Abdelrahman"
    },
    {
      "affiliations": [
        "Maharishi Markandeshwar College of Medical Science and Research, Sadopur Ambala, India"
      ],
      "name": "Shivam Mehta"
    },
    {
      "affiliations": [
        "Trinity Health Oakland, Oakland, Michigan, United States"
      ],
      "name": "Vivek Mittal"
    },
    {
      "affiliations": [
        "Independent Researcher, Triolet, Mauritius"
      ],
      "name": "Kamleshun Ramphul"
    },
    {
      "affiliations": [
        "Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom"
      ],
      "name": "Raheel Ahmed"
    }
  ],
  "title": "461 Trends and predictors of palliative care use in patients with end-stage heart failure and chronic obstructive pulmonary disease in the United States",
  "uid": "c7406150-0be6-535b-9f06-a5010b9338b8"
}