Key result
Cardiologists in regions with high health care use at the end of life were significantly less likely to discuss palliative care for advanced heart failure compared to those in low use regions (23% vs 32%, p=0.04).
Why the study?
Are cardiologists in regions with high end-of-life health care use less likely to discuss palliative care for patients with advanced heart failure?
Cross-Sectional (n=598)
Are cardiologists in regions with high end-of-life health care use less likely to discuss palliative care for patients with advanced heart failure?
Cardiologists in regions with higher end-of-life health care use are less likely to discuss palliative care with advanced heart failure patients, highlighting significant guideline discordance.
Suggests regional variation may reduce palliative care discussions in advanced HF; leaves open causal factors and intervention targets.
OBJECTIVES: Regional variation in health care use in the last 6 months of life is well documented. Our objective was to examine whether an association exists between cardiologists' tendencies to discuss palliative care for patients with advanced heart failure and the regional use of health care in the last 6 months of life. METHODS: We performed a national mail survey of a random sample of 994 eligible Cardiologists from the American Medical Association Masterfile. Hypothetical patient scenarios were used to explore physician management of patient scenarios. RESULTS: We received 614 responses (response rate: 62%). In a 75-year-old with symptomatic chronic heart failure and asymptomatic nonsustained ventricular tachycardia, cardiologists in regions with high use in the last 6 months of life were less likely to have discussions about palliative care (23% versus 32% for comparisons between the highest and lowest quintiles, p = 0.04). Similarly, in an 85 year-old with symptomatic chronic heart failure and an acute exacerbation, cardiologists in high use regions were less likely to have discussions about palliative care (35% versus 47%, p = 0.0008). CONCLUSIONS: Despite professional guidelines suggesting that cardiologists discuss palliative care with patients with late stage heart failure, less than half of cardiologists would discuss palliative care in two elderly patients with late-stage heart failure and this guideline discordance was worse in the regions with more health care use in the last 6 months of life.
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Matlock et al. (2010) conducted a cross-sectional in Advanced heart failure (physician practice patterns) (n=598). High regional use of health care in the last 6 months of life vs. Low regional use of health care in the last 6 months of life was evaluated on Tendency to initiate or continue discussions about palliative care in a 75-year-old with symptomatic chronic heart failure and asymptomatic nonsustained ventricular tachycardia (p=0.04). Cardiologists in regions with high health care use at the end of life were significantly less likely to discuss palliative care for advanced heart failure compared to those in low use regions (23% vs 32%, p=0.04).
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