Association of Gender and Palliative Care Needs Among Patients with Heart Failure.

1. Describe gender differences in palliative care needs among patients with heart failure. 2. Reflect how gender-specific aspects impact palliative care consultations and palliative care delivery for patients with heart failure. Among hospitalized patients with heart failure who received palliative care consultations, women have a higher symptom burden and are more often impaired in their functional status and capacity to designate a surrogate decision maker as compared to men. Dedicated efforts to address the palliative care needs of women with heart failure are needed. Palliative care is increasingly considered an important component of heart failure (HF) management. (1) We hypothesized that there might be gender differences in patient characteristics, symptom burden and level of impairment among patients with HF who receive palliative care consultations. This retrospective study included patients hospitalized with a primary diagnosis of HF who received an initial palliative care consultation in the Mount Sinai Health System. Patient characteristics, ICD codes, and the palliative care consult assessments including the Karnofsky Performance Status (KPS) and the Edmonton Symptom Assessment Scale (ESAS) were extracted from the electronic health record. (2,3) The population was stratified according to self-identified gender. Among 667 patients with HF who received a palliative care consultation, 327 (49.0%) were women. As compared to men, women were older (77.0 ± 16.7 years vs. 71.2 ± 15.2, p< 0.001) , more likely to be widowed (22.3% vs. 7.8%, p< 0.001) and less likely to be admitted to an intensive care unit (15.5% vs. 28.5%, p< 0.001). At the time of palliative care consult, women had worse functional status (KPS 35.4 ± 16.3 vs. KPS 39.7 ± 17.3, p< 0.001) and were less likely to have capacity to designate a surrogate decision-maker (62.2% vs. 70.7%, p< 0.001). In addition, women had a higher ESAS total symptom distress score (20.8 ± 10.5 vs. 18.2 ± 10.8, p=0.004) and were more likely to report severe symptoms (41.9% vs. 28.5%, p< 0.001). Besides, women were more likely to have completed a do not resuscitate / do not intubate order at the time of discharge (59.0% vs. 50.9%, p=0.01). As compared to men, women with HF were more severely impaired at the time of palliative care consult. Dedicated efforts to address the palliative care needs of women with HF are needed. Disease specific management / Diversity, Equity, Inclusion, Belonging, Justice [ABSTRACT FROM AUTHOR]