Abstract 270: Emergency Service Use in Heart Failure Patients on Hospice

Abstract

Introduction: Emergency service use should be almost non-existent among hospice patients, as hospice is intended to provide for all care needs at the end of life. Cancer patients comprise almost 50% of hospice patients nation-wide and have relatively low rates of emergency service use while on hospice care. Hospice enrollment has been steadily increasing among patients with heart failure, but concerns have been raised about how well hospice care meets these patients’ needs. Emergency service use is one indicator of how well heart failure patients’ needs are met on hospice. Objective: To explore whether emergency service use is higher among heart failure patients on hospice as compared to cancer patients on hospice and reasons for this potential disparity. Methods: This is a secondary analysis of the 2007 National Home and Hospice Care Survey (NHHCS). Only hospice patients with heart failure (n=311) and hospice patients with breast, prostate, colon or lung cancer (n=946) were included in the analysis. Emergency service use was measured by response to NHHCS question 73 (“did the patient use one or more types of emergent care?”) and includes the use of both emergency room and outpatient (urgicenter) services. Multiple logistic regression was used to examine the relationship between emergency service use and diagnosis. All analyses were adjusted for hospice length of stay, patient age, race/ethnicity, caregiver relationship, number of comorbidities, functional status, cognitive function and place of care. Results: Subjects (M age 75.3, SD 12.68) were 51% female and 89% white. The rate of emergency service use was 9.6% among the cancer patients and 17.36% among heart failure patients. Heart failure patients were almost two times more likely to utilize emergency services (OR 1.96, p<.002). Among the covariates examined, only hospice length of stay was significantly associated with emergency service use (p<.000), but did not appear to make a clinically significant difference (OR 1.003). Conclusions: While this study lends support to the hypothesis that heart failure patients suffer unmet care needs while on hospice, the nature of these unmet needs should be further explored. Outcome disparities have previously been suggested to be due to differences in age, comorbidities and functional status between the heart failure and cancer populations, but this study does not support that hypothesis. Hospice care plans unique to the heart failure patient should be considered.