Among myocardial infarction (MI) patients only about 1% receive palliative care, even for patients who have a terminal prognosis, according to recent research. These patients represent an underserved population who need care as well as an untapped market for palliative care providers.
Most of the (MI) patients who did receive palliative care died during hospitalization, the study found. Despite the low rates, the data reflects some improvement. Among those who died, close to one-third underwent a palliative care consultation, up from 1.5% in 2002.
Researchers used data from the National Inpatient Sample for 2002 through 2016.
“Several studies have investigated the patterns of palliative care utilization in other critical illnesses such as heart failure and stroke, but not for acute myocardial infarction,” Cardiologist and lead researcher Islam Elgendy, M.D. of Massachusetts General Hospital told Hospice News. “Reassuringly, we found an increase in the utilization of palliative care during the study period, but overall it is still underutilized.”
Palliative care consultation can reduce direct hospital costs by $3,000 per patient admitted, and up to $4,800 per admission for patients suffering from four or more diagnoses, according to a 2018 study.
Currently 72% of hospitals in the United States with 50 or more beds have a palliative care program. This is up from 67% in 2015 and 7% in 2001, according to the Center to Advance Palliative Care (CAPC). These institutions care for 87% of all hospitalized patients nationwide. Large nonprofit hospitals in large cities are the most likely to provide palliative care.
Rural areas remain grievously underserved. Only 17% of hospitals with 50 beds or more in rural communities offer palliative care, compared with 90% of hospitals in urban areas, CAPC has reported.
Underutilization can be attributed to a number of factors, but misconceptions about the nature of palliative care is one of the chief contributors, as is a lack of awareness.
A Journal of Palliative Medicine studyfound that as many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice.
Close to 60% of patients who would benefit from palliative care do not receive those services, despite the availability of community-based palliative care as well as hospital-based palliative care, according to a report from the New England Journal of Medicine Catalyst Insights Council.
“Prior studies in the ICU setting suggest that the lack of knowledge and skills in palliative care among the treating physicians, the view of intensive care and palliative care as mutually exclusive, and the unrealistic expectations of patients, families, and physicians regarding treatment are among the barriers for palliative care utilization,” Elgendy said.