Guess which specialty's referral rates have actually declined ...
People with cardiovascular disease (CVD) usually aren't getting referred to palliative care until late in their illness, and few referrals come from cardiologists, a registry showed.
The proportion entering palliative care at low palliative performance scores (≤30%), consistent with bed-bound patients requiring total care, remained stable over time at an average of 28.9% from 2015 through 2017.
Referrals from cardiologists fell from 16.5% in 2015 to 10.5% in 2017, reported Arif Kamal, MD, of Duke University Medical Center in Durham, North Carolina, and colleagues in JAMA Network Open.
"These findings reinforce the need for cardiologists to be more engaged with [palliative care] and consider referring appropriate patients with CVD sooner," the group concluded.
Hospice is just a subset of palliative care, which actually "does not have prognosis or disease severity requirements and aims to be included in care from the time of diagnosis onward" to support quality of life for patients, Kamal's group noted.
The downward trend in referral by cardiologists "could be explained in part by the rapidly increasing registry membership during the study," noted an accompanying editorial by David Bekelman, MD, MPH, of the VA Eastern Colorado Health Care System in Aurora. However, "the low proportion of referrals is concerning."
The study included data on 1,801 adults with CVD, referred for a first palliative care consultation at 16 sites, who had a documented palliative performance score recorded in the multicenter Quality Data Collection Tool for Palliative Care registry from Jan. 2, 2015 through Dec. 29, 2017.
Nearly three-quarters of the cohort was white, and the proportion of racial and ethnic minorities actually decreased through time. Black patients comprised 11.9% in 2015 but 6.3% in 2017.
Bekelman cautioned that looking at only functional status misses other markers of illness trajectory, such as time from diagnosis, time to death, and patient-reported health status. "Other issues to consider regarding the lack of change in functional status are the relatively short study time (3 consecutive years) and the study sites (a single site contributed more than one-third of the patients)," he added.
Kamal disclosed no relevant relationships with industry.
Bekelman disclosed funding from the U.S. Department of Veteran Affairs Health Services Research and Development Service.
JAMA Network Open
Source Reference: Warraich HJ, et al "Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care" JAMA Network Open 2019; DOI: 10.1001/jamanetworkopen.2019.2375.
JAMA Network Open
Source Reference: Bekelman DB "Improving Primary and Specialist Palliative Care in Cardiovascular Disease" JAMA Network Open 2019; DOI: 10.1001/jamanetworkopen.2019.2356.
Read the original article on Medpage Today: Palliative Care Rates in Heart Disease Not Improving