Abstract Body (Do not enter title and authors here):
Introduction:
The use of palliative care services in adults with congenital heart disease (ACHD) has demonstrated many benefits including clarity relating to goals of care and improved quality of life, though it remains underutilized. There is limited data regarding national trends in its use in the ACHD population nearing the end of life.

Research Question:
To explore trends of palliative care consults amongst adults with moderate to great complexity ACHD nearing mortality.

Methods:
We utilized the Nationwide Readmissions Database between the years 2016-2022 to identify adult patients with mortality and an underlying diagnosis of moderate to great complexity congenital heart disease. We investigated the occurrence of palliative care consults amongst these patients during their terminal hospitalization and during any recent hospitalization within 90 days. Trend analysis was performed. The relevant ICD-10 codes were identified.

Results:
A total of 4,158 patients with moderate-great complexity ACHD had a mortality during the study period. This represented 4% of the total hospitalizations for the study population. Their median age was 62.5 years and 51% were male. Congestive heart failure (56%) and hypertension (54%) were the most common comorbidities. The mean Elixhauser Comorbidity Index was 6.1. The in-hospital mortality amongst all hospitalizations increased from 3.9% in 2016 to 4.4% in 2022. The number of palliative care consults for patients with in-hospital mortality also increased from 38.9% in 2016 to 54.2% in 2022 (p < 0.01). About 10% of patients had another hospitalization within the 90 days prior to their terminal hospitalization; 8% had a palliative care consult placed during the prior hospitalization.

Conclusions:
There has been a steady increase in the uptake of palliative care consults between the years 2016 and 2022 amongst ACHD patients during hospitalizations resulting in mortality. However, there remains a need for increased awareness as nearly half of all patients die without receiving any formal palliative care consultation while in-patient. Additionally, only a small minority of ACHD patients hospitalized within the 90 days prior to their terminal hospitalization received a palliative care consult. This highlights opportunities to involve palliative care clinicians earlier in the course of disease for ACHD patients, which may prevent recurrent hospitalizations and ensure a goal-concordant plan of care.