Palliative care utilization following out-of-hospital cardiac arrest in the United States

Aims: Palliative care (PC) has become an integral component of comprehensive care provided to critically ill patients. Little is known about the utilization of palliative care following Out-of-Hospital Cardiac Arrest (OHCA) in the United States. Methods: We used the 2002–2013 National Inpatient Sample database to identify adults ≥18 years old with an ICD-9-CM principal diagnosis code of cardio-respiratory arrest or ventricular fibrillation (VF). Patients were categorized into two groups based on the presence of PC, then compared using Pearson χ² test for categorical variables and linear regression for continuous variables. Multiple linear and logistic regression models were conducted to identify factors associated with PC, and temporal trends in PC utilization. Results: Of the 154,177 patients hospitalized with OHCA in the U.S, 11,260 (7.3%) had PC consultations during hospitalization. PC Utilization increased from 1.5% in 2002 to 16.7% in 2013 (P-trend < 0.001). Patients who received Palliative care were older (mean age 70.7 ± 0.3 vs 65.9 ± 0.1), more likely to be female (45.8% vs 40.5%), and had higher Charlson comorbidity index ≥2 (55.8% vs 46.8%). In adjusted analyses, older age, female gender, Caucasian race, higher Charlson comorbidity index, multiorgan failure, metastatic cancer, non-shockable rhythm, admission to larger, urban and teaching hospitals were all associated with higher PC utilization. Conclusion: We observed significant increase in the utilization of palliative care consultations following OHCA over the study period. This was influenced by multiple patient and hospital factors. Further investigations are needed to identify the appropriate cost-effective use of palliative care following cardiac arrest.