Pulmonary arterial hypertension (PAH) is a progressive disease associated with significant morbidity and mortality. Despite the negative impact of PAH on quality of life and survival, data on utilization of specialty palliative care services (PCS) is scarce.
We sought to evaluate the inpatient utilization of PCS in patients with PAH.
Using the National Inpatient Sample, 30,495 admissions with a primary diagnosis of PAH were identified during 2001 to 2017. The primary outcome of interest was temporal trends and predictors of inpatient PCS utilization in patients with PAH.
The inpatient utilization of PCS was low (2.2%) but increased during the study period from 0.5% in 2001 to 7.6% in 2017, with a significant increase starting in 2009. White race, private insurance, higher socioeconomic status, hospital-specific factors, higher comorbidity burden (Charlson Comorbidity Index), cardiac and non-cardiac organ failure, use of extracorporeal membrane oxygenation and non-invasive mechanical ventilation were independent predictors of increased PCS utilization. PCS use was associated with a higher prevalence of do-not-resuscitate status, a longer length of stay, higher hospitalization costs and increased in-hospital mortality with less frequent discharges to home, likely because these patients were also sicker (higher comorbidity index and illness acuity).
The inpatient utilization of PCS in patients with PAH is low but increasing over recent years. Despite increased PCS utilization over time, there continues to be patient and hospital-specific disparities in PCS utilization. Further studies evaluating these disparities and the role of PCS in the comprehensive care of PAH patients are warranted.
Copyright © 2020. Published by Elsevier Inc.