In-hospital utilization of palliative care services in patients with cardiac amyloidosis

Introduction Cardiac amyloidosis is a progressive and often fatal condition characterized by the deposition of abnormal protein fibrils in the heart, leading to heart failure and other cardiovascular complications. In recent years, there has been growing recognition of the potential benefits of palliative care in managing complex cardiac conditions, including cardiac amyloidosis especially with multiple comorbidities and advancing age. Identifying risk factors can help with deciding management plans, resource utilization and improving physician-patient communication. Method We analyzed data from the National Inpatient Sample to identify patients who were admitted with a diagnosis of breast cancer in 2021. Among this population, we isolated patients with Cardiac amyloidosis and associated cardiomyopathy. We checked if this cohort of patients utilized palliative care (PC) services during that hospital stay. We investigated the baseline characteristics of those with and without PC. The primary endpoint was in-hospital mortality, stratified by PC utilization. We also examined other outcomes such as length of stay (LOS), total charge (TOTCH). Additionally, we explored independent predictors of in-hospital mortality. Result Of 12,604 admissions for cardiac amyloidosis in 2021, 1,519 (12%) received palliative care (PC) referrals. Patients receiving PC were older (mean age 78 vs. 74 years, p<0.01) and had higher in-hospital mortality (32% vs. 4%, p<0.01). PC referrals were more common in patients with congestive heart failure (93% vs. 88%), supraventricular tachycardia (23% vs. 17%), atrial fibrillation (67% vs. 61%), and acute kidney injury (65% vs. 42%) (all p<0.05). Independent predictors of mortality included acute kidney injury (aOR 2.88, 95% CI 1.88-4.41) and multiple myeloma (aOR 1.74, 95% CI 1.06-2.85). Chronic anticoagulation was associated with lower inpatient mortality (aOR 0.6, 95% CI 0.43-0.95). PC patients had longer lengths of stay (9 vs. 7 days) and higher hospitalization costs ($101,717 vs. $94,395). Conclusion Palliative care utilization in patients with cardiac amyloidosis is associated with higher in-hospital mortality, reflecting its use in more severe cases. The identification of factors such as acute kidney injury and multiple myeloma as independent predictors of mortality highlights the need for early palliative care integration in high-risk patients. The protective effect of chronic anticoagulation warrants further investigation. These findings underscore the importance of timely palliative care referrals and may guide resource allocation for patients with cardiac amyloidosis with multiple comorbidities.