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Only about 12.5% of patients with heart failure in the United States receive a palliative care consultation within five years of their diagnosis, according to a study from Saint Louis University published in the Journal of the American Heart Association. Black patients are 15% less likely than white patients to receive this important form of care, highlighting stark racial and geographic disparities. These gaps are particularly concerning given the higher cardiovascular disease risks and mortality rates among Black populations.
Led by Zidong Zhang, Ph.D., of Saint Louis University’s AHEAD Institute, this study is the first to examine the use of palliative care among heart failure patients across the general U.S. population. Previous research had focused on specific groups, such as Medicare beneficiaries or veterans. Using a national all-payer database, the researchers analyzed data from nearly 170,000 patients aged 18 to 80 between 2011 and 2018.
The findings revealed important disparities. Patients with less severe complications, such as those receiving inotropic therapy without cardiogenic shock, were less likely to receive palliative care consultations. However, those experiencing cardiogenic shock—a critical condition requiring advanced treatments—were nearly three times as likely to receive palliative care. This inconsistency may stem from the complexity of managing advanced cases and clinical hesitation in initiating palliative care discussions earlier in the disease course.
Heart failure is a progressive, life-limiting condition, yet the integration of palliative care remains infrequent and inequitable. Black patients, who face disproportionately higher rates of heart failure and cardiovascular-related deaths, are particularly affected by these disparities. The American Heart Association (AHA) has long recommended early integration of palliative care for heart failure patients, especially for those being evaluated for advanced therapies, but this study highlights how far real-world practice lags behind these guidelines.
According to Zhang, addressing these gaps will require systemic reforms, including removing financial barriers to concurrent care, expanding outpatient and community-based palliative care services, and improving physician training on when and how to begin palliative care discussions. Streamlined care transitions from cardiac care to palliative care teams may also help ensure timely and equitable access to these services. Without these reforms, many patients with heart failure will continue to miss out on care that could improve their quality of life and overall outcomes.