Palliative Care Consultation in ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock; Insights from the Nationwide Inpatient Sample

Ando, Tomo

Palliative Care Consultation in ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock; Insights from the Nationwide Inpatient Sample

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Tomo Ando, M.D. , Wayne State University/Detroit Medical Center Program/Harper University, Detroit, MI

Emmanuel Akintoye, MD, MPH , Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa city, IA

Oluwole Adegbala, MD, MPH , Englewood Hospital and Medical Center, Englewood, NJ

Said Ashraf, MD , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Mohamed Shokr, MD , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Hisato Takagi, MD, PhD , Shizuoka Medical Center, Shizuoka, Japan

Cindy L. Grines, M.D., MSCAI , ., New York, NY

Luis Afonso, MD , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Alexandros Briasoulis, MD, PhD , University of Iowa Hospitals and Clinics, Iowa, IA

Background
ST-segment elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS) is associated with extremely high mortality. We investigated the utilization and predictors of palliative care (PC) consult in this cohort.

Methods
Nationwide inpatient sample from 2005-2014 was queried to identify those with STEMI-CS and age ≥18. Trends and independent predictors of PC as well as related procedures, length of stay, and hospitalization cost were examined.

Results
A total of 33,294 admissions were identified, of which 5.6% (1,878) had PC encounter. Those who had PC encounter were significantly older (73.1 vs. 66.30, p<0.001) and had higher comorbidities (Elixhauser score ≥4, 37.2% vs. 25.2%, p<0.001). Use of PC increased approximately 10 times over the study period in both who died (2.3% to 27.4%) and who survived (0.21% to 2.83%) (both p trend < 0.001, 2005-2014). Age (per 10 years increase adjusted odds ratio [aOR] 1.49), Exlixhauser score (aOR 1.11), no revascularization (aOR 1.93), coronary artery bypass (aOR 0.25) (all p<0.001) and mechanical circulatory support (aOR 1.14, p=0.02) were important predictors of PC consult whereas PCI was not. Median hospital cost (28,996 vs. 35,288 dollars) and length of stay (4 vs. 6 days) were lower and shorter in PC cohorts.

Conclusions
PC utilization increased dramatically during the 10-years study period in the United States in STEMI-CS. Revascularization strategy differed significantly between who did and did not have PC and there was a large difference in PC utilization between who died and survived.