Abstract 2379: Use of Hospice and Acute Care in Heart Failure vs. Cancer at End-of-Life

Abstract

Advances in heart failure (HF) have prolonged survival but more patients (pts) die from HF than from any type of cancer. Quality of care improvement for HF has focused largely on initiation of life-saving treatments. Pts dying of HF were less likely to be supported by hospice and more likely to die in hospitals than pts with terminal cancer. Two end-of-life cohorts (HF and cancer) were identified using Medicare data. The HF cohort consisted of pts with 2 HF hospitalizations before cardiac death. The cancer cohort had registry-defined solid-organ cancer and death attributed to cancer. We assessed hospice use, ER visit, and acute hospitalization during 30 days prior to death and deaths in hospitals. Time trend and predictors of hospice use were also assessed. Among 7,930 HF pts with median age 82, 78% female and 5% black, 20% were referred to hospice compared to 51% in 7,565 cancer patients. The mean duration of hospice prior to death was longer with heart failure (68 for HF and 15 days for cancer). A modest rise in hospice use over time was parallel in the two groups. Acute care prior to death was higher for HF than cancer pts. (59 vs. 40% for ER visit and 62 vs. 45% for hospitalizations). More HF pts died in acute care hospitals than cancer pts (37 vs. 21%). Younger age, male gender, black race and dialysis therapy were associated with lower use of hospice in multivariate analyses. Although hospice use is increasing slowly over time, the contribution of hospice remains lower in HF, and more HF deaths occur in acute care settings. Further studies are needed to assess indications for hospice and acute care services in HF patients at the end of life.