Palliative care referral in ST-segment elevation myocardial infarction complicated with cardiogenic shock in the United States Tomo Ando a, *, Emmanuel Akintoye b , Takeshi Uemura c , Oluwole Adegbala d , Said Ashraf a , Mohit Pahuja a , Mohamed Shokr a , Hisato Takagi e , Cindy L. Grines f , Luis Afonso a , Alexandros Briasoulis b a Division of Cardiology, Wayne State University, Detroit Medical Center, 3990, John R, Detroit 48201, MI, United States b University of Iowa Hospitals and Clinics, Iowa, Iowa, United States c University Health Partners of Hawaii, John A Burns School of Medicine University of Hawaii, Honolulu, Hawaii, United States d Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, United States e Shizuoka Medical Center, Shizuoka, Japan f North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY, United States ARTICLE INFO Article History: Received 15 May 2019 Revised 13 October 2019 Accepted 16 October 2019 Available online xxx ABSTRACT Background: ST-segment elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS) is associated with high mortality but the trends of utilization and predictors of palliative care (PC) referral in this population have not been well described. Objectives: To investigate the utilization trends and predictors of PC referral in STEMI-CS. Methods: Nationwide inpatient sample from 2005 2014 was queried to identify patients with STEMI-CS of age 18. PC referral was identified International Classification of Diseases, Ninth Edition Clinical Modifica- tion, V66.7. Results: A total of 33,294 admissions were identified and 1,878 (5.6%) had PC encounter. PC referral group were older and had higher comorbidities. PC consultation increased approximately 10 times over the study period in those who died (from 2.3% to 27.4%) and in those who survived (from 0.21% to 2.83%). In multivari- able analysis, age, higher Exlixhauser score, no revascularization, teaching hospital, large bed hospital, mechanical circulatory support use, and lower income status were associated with increased PC referral whereas coronary artery bypass graft was associated with lower PC referral rates. Patients under PC group were more often discharged to an extended care facility and less likely discharged home. Conclusion: PC utilization increased substantially during the 10-years study period in the United States in STEMI-CS. Several baseline, procedural, hospital, and socioeconomic factors were associated with PC referral in the setting STEMI-CS. © 2019 Elsevier Inc. All rights reserved. Keywords: Cardiogenic shock Palliative care ST-segment elevation myocardial infarction Introduction Cardiogenic shock continues to have unacceptably high in-hospi- tal mortality of over 50% and ST-segment elevation myocardial infarction (STEMI) is the leading cause of cardiogenic shock among other causes such as myocarditis, non-ST-elevation myocardial infarction, acute exacerbation of chronic heart failure, and pulmonary embolism. 1 STEMI resulting in left ventricular failure accounts for 70 80% of STEMI complicated with cardiogenic shock (STEMI-CS) and the prevalence of STEMI-CS was 6.5 to 10.1% in the United States between 2003 2010. 1 4 Despite a declining trend in mortality of STEMI-CS because of early revascularization 5,6 and increased use of mechanical circulatory support (MCS) devices, 7 STEMI-CS remains a significant cause of morbidity and mortality. 1,2,6,8 Management of STEMI-CS is complex, and disease course varies from rapid demise of the patient to prolonged hospital course in the intensive care unit. In addition, various treatment options including revascularization and MCS are time sensitive and decisions need to be made in a timely manner among physicians, patients and care- givers. This can be challenging given the acuity of the disease and the burden of stress on caregivers and patients. Palliative care (PC) has been shown to enhance patient satisfac- tion, improve care providers’ communication, and reduce total health care cost. 9,10 PC consultation can be a potentially useful intervention in STEMI-CS given its high mortality but the use of PC has not been well studied in this population. Indeed, STEMI-CS is not discussed in the policy statement from the American Heart Association on PC in *Corresponding author. E-mail address: tomo.ando@wayne.edu (T. Ando). https://doi.org/10.1016/j.hrtlng.2019.10.005 0147-9563/© 2019 Elsevier Inc. All rights reserved. ARTICLE IN PRESS Heart & Lung 000 (2019) 1 5 Contents lists available at ScienceDirect Heart & Lung journal homepage: www.heartandlung.com