Background: Heart failure (HF) is a chronic illness typically associated with multiple co-morbidities. Nearly 6 million people have HF, with the incidence approaching 1 in 100 adults over the age of 65. HF is the most common cause of hospitalization among adults over the age of 65 and admission rates for this disease have increased steadily over the last two decades. Even with current therapies, HF patients experience high symptom burden and mortality over the course of a prolonged and unpredictable illness. Symptomatic HF confers a worse prognosis than most cancers, with a one-year mortality of approximately 45 percent. Despite these numbers, less than 10% of patients with HF receive any form of palliative care;as of 2007, less than 12% of hospice admissions were patients with HF. Unlike the growing evidence of the benefits of palliative care for patients with cancer, there is a paucity of data regarding the potential benefit of an early palliative care intervention for older patients with HF. Palliative care has the potential to improe clinical outcomes for older patients facing HF by improving pain and other symptom control, clarifying goals of care, and guiding treatment decisions to meet goals. We hypothesize that these elements will translate into reduced healthcare utilization and cost. Objective: The goal of this proposal is to assess better the effect of palliative care consultation on utilization and coss of older adults with HF.
Specific Aim 1 : To compare the difference in healthcare utilization, including costs of hospitalization, length of stay, number of days in the intensive care unit (ICU) number of rehospitalizations and hospice enrollment at discharge among older patients with HF who received palliative care and those who received usual care.
Specific Aim 2 : To determine differences in healthcare utilization (as above) between younger (<65 years), older (65 to 84 years), and the oldest old (>85 years) patients with HF who received palliative care and those who received usual care. Methods: To address these aims, a secondary data analysis will be performed of the Palliative Care Leadership Center's (PCLC) Outcomes database, a unique database of hospital administrative and cost data from 8 geographically and structurally diverse hospitals representing low-, middle, and high-cost markets served by 6 palliative care consultation teams. The dataset includes hospital administrative data of patients aged 18 years or older with lengths of stay from 7 to 30 days between 2002 and 2004 who received palliative care and those who did not. Discussion: Data comparing the healthcare utilization of younger, older, and oldest old patients with HF will guide when palliative care will have the greatest benefit and direct policy efforts to improve quality of care and minimize healthcare cost. The results of this study will inform a future prospective cohort study comparing symptoms, survival and healthcare utilization for hospitalized older adults with HF who receive palliative care consultation with those who do not. This will create a better understanding of the benefits of palliative care to this population - a key first step in improving the quality of care for older adlts with HF.

Public Health Relevance

Because heart failure (HF) is a disease of older adults, with more Medicare dollars spent on the diagnosis and treatment of HF than any other diagnosis, it is critical to gain an understanding of how palliative care can be directed to best care for this population of older patients living with HF. By understanding these differences in healthcare utilization and cost for older patients, an early palliative care consultation can effectively targt the different population segments of older adults and thereby, have significant Medicare implications for improving quality of care and minimizing cost of care.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1-ZIJ-9 (M1))
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Salive, Marcel
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Gelfman, Laura P; Lindenberger, Elizabeth; Fernandez, Helen et al. (2014) The effectiveness of the Geritalk communication skills course: a real-time assessment of skill acquisition and deliberate practice. J Pain Symptom Manage 48:738-44.e1-6
Gelfman, Laura P; Kalman, Jill; Goldstein, Nathan E (2014) Engaging heart failure clinicians to increase palliative care referrals: overcoming barriers, improving techniques. J Palliat Med 17:753-60
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