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Publications

Journal Article Ahead of print

PubMed: 42570547 DOI: 10.1016/j.jemermed.2026.07.011

The Impact of Emergency Department Initiated Palliative Care for Heart Failure Patients.

J Emerg Med 88:152-163

Authors: Madison Dixon, Kevin Dyer, Meghan Harrington, Emily Peoples, Wen-Chih Wu, Lan Jiang, Cristina Vellozzi-Averhoff, Ma Jensy Stafford, Mitchell Wice

Affiliations

  • Division of Geriatrics and Palliative Medicine, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
  • Division of Geriatrics and Palliative Medicine, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
  • Division of Cardiology, Department of Medicine, The Warren Alpert Medical School of Brown University, Rhode Island; Center of Innovation on Transformative Health Systems Research to Improve Veteran Equity and Independence (THRIVE COIN), Providence VA Medical Center, Providence, Rhode Island.
  • Center of Innovation on Transformative Health Systems Research to Improve Veteran Equity and Independence (THRIVE COIN), Providence VA Medical Center, Providence, Rhode Island.
  • Division of Geriatrics and Palliative Medicine, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Center of Innovation on Transformative Health Systems Research to Improve Veteran Equity and Independence (THRIVE COIN), Providence VA Medical Center, Providence, Rhode Island; Geriatrics and Extended Care, Providence VA Medical Center, Providence, Rhode Island.

Abstract

BACKGROUND

The Emergency Department (ED) frequently cares for patients with heart failure (HF). There is a paucity of literature evaluating the effect of Palliative Care (PC) on ED utilization amongst patients with HF.

OBJECTIVES

Evaluate the effects of early PC consults on subsequent ED utilization after discharge for patients with HF.

METHODS

We evaluated Veterans admitted to Veterans Administration (VA) hospitals for HF exacerbation between 2010 and 2024. We compared early versus standard versus no PC. Early PC is defined as completion of consultation within 24 h of ED presentation. Standard PC is defined as PC involvement after 24 h of presentation. Our primary outcome is defined as ED visit or rehospitalization within 180 d of discharge.

RESULTS

Among 126,775 HF Veterans with 207,364 ED visits, 1669 (0.8%) veterans received early PC, 7101 (3.4%) received standard PC and 198,594 (95.8%) received no PC. Proportional hazard modeling with facility fixed effects and competing risk adjustment found that early PC regardless of timing was associated with a significant reduction in time to ED use or readmission compared to those without PC.

CONCLUSION

Patients admitted with diagnosis of HF exacerbation have less subsequent ED utilization when receiving PC. This presents a unique opportunity for ED initiated PC involvement for a patient cohort known to have high hospital resource utilization.

MeSH

Emergencies, Heart Failure, Heart, Emergency Medicine, Palliative Care, Emergency Service, Hospital