30-Day Readmission Rates in Patients Admitted for Heart Failure Exacerbation with and without Palliative Care Consultation: A Retrospective Cohort Study

Background: Palliative care consultation improves quality of care through symptom management, communication, care coordination, and earlier hospice referral, and it may decrease burdensome hospital readmissions at the end of life. Objectives: To compare 30-day readmission rates for patients admitted with exacerbation of congestive heart failure (CHF) receiving palliative care consultation services compared with controls. Design: Retrospective cohort study using propensity score matching. A secondary, subgroup analysis compared patients with palliative care consults and patients with an incomplete consult order. Settings/Subjects: Single-center study in an academic acute inpatient setting. Of a pool of 8215 admissions from January 1, 2011 to April 6, 2014, 356 included a palliative care consultation, and 356 matched controls were found. Results: The 30-day readmission rate was 50.8% for admissions including a palliative care consult and 36.0% for controls (OR 1.8, 95% CI 1.4-2.5). Those with a completed consult had fewer readmissions compared with those with an incomplete order, but this difference was not statistically significant (43% vs. 53%, ‡ 2 = 1.9, p = 0.171). Conclusion: No reduction in the risk of 30-day readmission was observed in the palliative care group, suggesting that palliative care services may not have the same effect on readmission rates in CHF patients compared with others. The subgroup analysis suggests that the difference between palliative care and control groups may reflect residual confounding, possibly due to critical social variables that are not captured in the electronic medical record, highlighting the difficulty in studying this population.