BackgroundThis study sought to evaluate the 15‐year national utilization, trends, predictors, disparities, and outcomes of palliative care services (PCS) use in cardiogenic shock complicating acute myocardial infarction.Methods and ResultsA retrospective cohort from January 1, 2000 through December 31, 2014 was analyzed using the National Inpatient Sample database. Administrative codes for acute myocardial infarction–cardiogenic shock and PCS were used to identify eligible admissions. The primary outcomes were the frequency, utilization trends, and predictors of PCS. Secondary outcomes included in‐hospital mortality and resources utilization. Multivariable regression and propensity‐matching analyses were used to control for confounding. In this 15‐year period, there were 444 253 acute myocardial infarction–cardiogenic shock admissions, of which 4.5% received PCS. The cohort receiving PCS was older, of white race, female sex, and with higher comorbidity and acute organ failure. The PCS cohort received fewer cardiac procedures, but more noncardiac organ support therapies. Older age, female sex, white race, higher comorbidity, higher socioeconomic status, admission to a larger hospital, and admission after 2008 were independent predictors of PCS use. Use of PCS was independently associated with higher in‐hospital mortality (odds ratio 6.59 [95% CI 6.37–6.83]; P<0.001). The cohort with PCS use had >2‐fold higher in‐hospital mortality, 12‐fold higher use of do‐not‐resuscitate status, lesser in‐hospital resource utilization, and fewer discharges to home. Similar findings were observed in the propensity‐matched cohort.Conclusions PCS use in patients with acute myocardial infarction–cardiogenic shock is low, though there is a trend towards increased adoption. There are significant patient and hospital‐specific disparities in the utilization of PCS.

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Advance care planning rates remain low, indicating a need to identify an approach that promotes acceptance of, and participation in, high-quality advance care planning by clinicians, patients, and families. A pilot study was conducted to evaluate the feasibility and acceptability of a nurse-led advance care planning intervention in primary care, comparing 4 advance care planning decision aids to help patients consider options; a 4-arm, prospective, comparative design was used with scripted discussions between 4 nurses and 40 patients in a large Midwestern clinic. The study procedures were determined to be feasible and acceptable. Most invited patients agreed to participate (40 of 66, 60%); 38 of 40 completed the intervention. Overall, patients and nurses were satisfied with the intervention. Changes in scores on the engagement survey were positive, indicating improvement across all groups. According to these preliminary data, 124 patients would be required in each group for a fully powered study. In addition, 34 of 40 patients (85%) completed an advance directive; all 40 patients identified a healthcare agent. The use of nurses to facilitate advance care planning with patients may be an opportunity to improve healthcare and patient outcomes and support full-scope nursing practice in primary care settings.