In-Hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

•Despite trending upward, the overall prevalence of palliative care usage is exceedingly low (14.1%).•One third of all patients with advanced heart failure complicated by cardiogenic shock requiring mechanical circulatory support died in hospital.•Amongst the palliative care cohort, we found a lower incidence of invasive procedures (such as pacemaker implantations, defibrillator implantations, insertion of percutaneous feeding tubes) and comparable complication rates (such as major bleeding and transfusion of any blood product) when compared with no palliative care use, in those who were discharged alive and those who died in hospital.•Utilizing a multivariate logistic regression model: older age, female sex, coronary artery disease, and number of procedures performed at the indexed hospitalization were main predictors for palliative care consultation. Prior studies have shown that the early inclusion of palliative care (PC) specialist is associated with better end-of-life experiences. The National Inpatient Sample Database was queried from 2012 to 2017 for relevant of ICD)-9 and -10 procedural and diagnostic codes to identify patients above 18 years with advanced heart failure (HF) admitted with cardiogenic shock (CS) requiring mechanical circulatory support (MCS). Baseline characteristics, utilization trends and invasive procedures and complications were compared among patients evaluated by PC and those who were not. There were 65,230 patients hospitalized for advanced HF complicated by CS requiring MCS, of these a PC consult was placed in in 9,200 patients (14.1%) and trended upward from 9.4 to 16.8%, between 2012 to 2017. The majority of patients, (37.3%) from the total population died in hospital. In reference to patients who were discharged alive, PC consultation was associated with a lower incidence of invasive procedures such as mechanical ventilation, pacemaker implantation, defibrillator implantation, insertion of percutaneous feeding tubes and tracheostomies performed (p