title: Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
abstract: BACKGROUND
  As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer.
  
  
  OBJECTIVE
  To characterize the unresolved symptom and treatment needs with which patients with HF and those with cancer present to PC.
  
  
  METHODS
  We used data from the Palliative Care Research Registry (PCRR), a repository of quality improvement data from three community-based PC organizations. We abstracted first PC visit data from the PCRR for patients with primary diagnoses of HF or cancer seen between 2008 and 2012. We assessed the association of primary diagnosis (i.e., HF or cancer) on three outcomes: unresolved symptoms, treatment gaps, and a composite indicator of symptom control and quality of life. Analyses included descriptive statistics and multivariate Poisson regression.
  
  
  RESULTS
  Our analytic sample comprised 334 patients with HF and 697 patients with cancer, the majority of whom were white and male. Compared to patients with cancer, patients with HF presented with fewer unresolved symptoms, both overall and at moderate/severe distress levels. Patients with HF more commonly reported moderately/severely distressful dyspnea (25% versus 18%, p=0.02), and more commonly experienced dyspnea-related treatment gaps (17% versus 8%, p<0.001).
  
  
  CONCLUSIONS
  Patients with HF possess care needs that are squarely within the purview of PC. Future work is needed to delineate how PC referral policies should be refined to optimize PC access for patients with HF.
authors.affiliation: 1 Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: Sandesh
authors.initials: S
authors.lastname: Dev
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006333:Heart Failure / Q000628:therapy*; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009657:North Carolina; D010166:Palliative Care / Q000458:organization & administration*; D011788:Quality of Life