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The case for palliative care in CV

September 6, 2017

    In recent years, palliative care has received growing attention in the press and become top-of-mind for many CV leaders. Hospitals across the country are making strides in adoption, thanks to palliative care's promise to enhance quality and reduce costs. But in the CV service line, palliative care still doesn't get the attention it deserves.

    Read on to learn why palliative care should be a priority at your CV program—and how to get the ball rolling.

    Palliative care is part of a high-value program

    Palliative care is an interdisciplinary method of caring for patients with serious and complex illnesses. Its defining goals include preventing and relieving suffering and symptoms, enhancing quality of life, incorporating shared decision-making, providing psychological and spiritual care, and planning for end-of-life care. In contrast to common misperceptions, however, palliative care is not limited to end-of-life. Rather, it is appropriate at any stage of a serious illness, including alongside curative treatments.

    Palliative care aligns well with one of CV programs' core missions: to improve care for chronic patients. But as CV patient populations become sicker and the push toward value accelerates, palliative care also takes on strategic significance. When applied effectively, palliative care has been proven to enhance value in CV care by improving quality while lowering cost.

    For example, a 2015 study showed that inpatient palliative care for patients with acute heart failure (HF) led to improvement in symptoms and quality of life, including depressive symptoms. Palliative care consults have also been shown to reduce 30-day readmissions, improve patient experience, and integrate the family in a supportive care environment. Additionally, palliative care has the potential to decrease costs: A study in patients with advanced HF referred for cardiac transplant found that palliative care reduced direct costs by nearly $1,700 per admission.

    Palliative care is still underutilized in CV

    Yet despite its benefits, palliative care remains underutilized in hospitals in general and in CV patients in particular. About 90% of U.S. hospitals with 300-plus beds have palliative care programs, compared with 56% of smaller hospitals. However, palliative care consults are provided to about 2 to 4% of patients at most hospitals, where experts in the field indicate the ideal is likely closer to 5 to 10%.

    When palliative care is utilized, it is traditionally in oncology patients, and it's not often considered for CV patients who could benefit. From 2009 to 2015, only 13% of palliative care patients had a primary cardiac diagnosis, which does not align with the high rate of CV disease (CVD) and strong society recommendations for palliative care use.

    That said, CV leaders have several opportunities to integrate palliative care into their programs, and should employ three strategies to do so.

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