Associate Professor University of Kentucky University of Kentucky, United States
Background: Palliative care consultation (PCC) is increasingly recognized as a vital component of care for hospitalized patients with serious illnesses such as infective endocarditis (IE), a condition associated with high morbidity and mortality. Prior studies have shown benefits of PCC in improving quality of life and facilitating goals-of-care (GOC) discussions, but data specific to IE are limited. We evaluated the utilization of PCC among hospitalized patients with IE and identified factors independently associated with PCC use.
METHODS AND RESULTS: We conducted a retrospective cohort study of adults diagnosed with IE by a multidisciplinary endocarditis team at University of Kentucky Healthcare between September 2021 and June 2024. Data were extracted from electronic health records, including demographics, comorbidities, hospital course, receipt of PCC, and documentation of GOC discussions. Patients were categorized based on PCC receipt, and comparisons were performed using univariate analyses. Variables with p< 0.20 in univariate analyses were entered into a multivariable logistic regression model to determine independent predictors of PCC.
Among 456 patients (176 females, 280 males), 95 (20.8%) received PCC. Among those who received PCC, 90 (94.7%) had a documented GOC discussion, with 22 (23.2%) subsequently discharged to hospice care. By comparison, 13 (3.6%) patients without PCC were discharged to hospice care. In-hospital mortality was higher in the PCC group (26.3%) than in the non-PCC group (6.4%, p < 0.001). The annual proportion of patients receiving PCC increased from 5.7% in 2021 to 43.6% in 2024 (Figure 1). Patients receiving PCC were significantly older (median age 60 vs. 45 years, p< 0.001) and more likely to have coronary artery disease (32.6% vs. 21.6%; p=0.012), chronic kidney disease (26.3% vs. 13.9%; p=0.004), and an ICU stay (69.5% vs. 5.2%; p=0.002) (Table 1). Multivariable analysis identified older age (odds ratio [OR] 1.04 per year; 95% confidence interval [CI] 1.02–1.07; p=0.002), active malignancy (OR 9.28; 95% CI 1.67–51.41; p=0.011), and consultation by cardiothoracic surgery (OR 2.48; 95% CI 1.11–5.57; p=0.027) as independent predictors of PCC.
Conclusion: PCC utilization among patients hospitalized with IE increased substantially during the study period, reflecting growing recognition of palliative care needs in this population. PCC was strongly associated with documentation of GOC discussions and hospice discharge. Independent predictors of PCC included older age, active malignancy, and cardiothoracic surgery consultation. These findings underscore the importance of integrating PCC early in the hospital course for patients with IE, particularly those with high-risk features.
