The following is a summary of “Palliative care referrals in patients with pulmonary arterial hypertension: The Pulmonary Hypertension Association Registry,” published in the January 2023 issue of Pulmonology by Rohlfing, et al.

Pulmonary arterial hypertension (PAH) is a chronic condition that has a high symptom burden and high healthcare costs. Palliative care, which has not been widely used for patients with critical illnesses, helps them cope with their physical and psychological difficulties. For a study, researchers sought to classify PAH patients who have been referred for palliative care and to determine referral factors.

They performed descriptive statistics on baseline patient characteristics for all patients, and the subset referred to palliative care in observational research of adult patients registered in the Pulmonary Hypertension Association Registry from January 2015 to June 2021. The factors were modeled in a backward elimination Cox regression with time to referral to palliative care as the main outcome.

Of the 1,578 patients, 92 (5.8%) were referred to palliative care, and 43% of those referrals were made at the final visit before death. Referrals were linked to older age per decade (hazard ratio 1.35 [95% CI 1.16-1.58]), lower BMI (hazard ratio 0.97 [95% CI 0.94-0.998]), use of supplemental oxygen (hazard ratio 2.01 [95% CI 1.28-3.16]), use of parenteral prostanoid (hazard ratio 2.88 [95% CI 1.84-4.51]), and worse quality of life (measured by lower physical (hazard ratio 0.97 [95% CI 0.95–0.99]) and mental scores (hazard ratio 0.98 [95% CI 0.96–0.995]) on the 12-item Short Form Health Survey. 

Even at centers of excellence, referrals for palliative treatment for patients with PAH remained uncommon. Patients who were sicker had poorer quality of life scores, and were frequently near the end of their lives were referred.

Reference: resmedjournal.com/article/S0954-6111(22)00331-6/fulltext