Unbound MEDLINE

In-hospital resource use and medical costs in the last year of life by mode of death (from the HF-ACTION randomized controlled trial).

Abstract

Patterns of medical resource use near the end of life may differ across modes of death. The aim of this study was to characterize patterns of inpatient resource use and direct costs for patients with heart failure (HF) who died of sudden cardiac death (SCD), HF, other cardiovascular causes, or noncardiovascular causes during the last year of life. Data were from a randomized trial of exercise training in patients with HF. Mode of death was adjudicated by an end point committee. Generalized estimating equations were used to compare hospitalizations, inpatient days, and inpatient costs incurred during the final year of life in patients who died of different causes, adjusting for clinical and treatment characteristics. Of 2,331 patients enrolled in the trial, 231 died after ≥1 year of follow-up with an adjudicated mode of death, including 72 of SCD, 80 of HF, 34 of other cardiovascular causes, and 45 of noncardiovascular causes. Patients who died of SCD were younger, had less severe HF, and incurred fewer hospitalizations, fewer inpatient days, and lower inpatient costs than patients who died of other causes. After adjustment for patient characteristics, inpatient resource use varied by 2 to 4 times across modes of death, suggesting that cost-effectiveness analyses of interventions that reduce mortality from SCD compared to other causes should incorporate mode-specific end-of-life costs. In conclusion, resource use and associated medical costs in the last year of life differed markedly in patients with HF who experienced SCD and patients who died of other causes.

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  • Publisher Full Text

    • Authors

    Reed SD, Li Y, Dunlap ME, Kraus WE, Samsa GP, Schulman KA, Zile MR, Whellan DJ

    Institution

    Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. shelby.reed@duke.edu

    Source

    The American journal of cardiology 110:8 2012 Oct 15 pg 1150-5

    MeSH

    Age Factors
    Aged
    Cause of Death
    Cost-Benefit Analysis
    Death, Sudden, Cardiac
    Exercise Therapy
    Female
    Health Resources
    Heart Failure
    Hospital Costs
    Humans
    Length of Stay
    Linear Models
    Male
    Middle Aged
    Risk Factors
    Statistics, Nonparametric
    Terminal Care

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    22762718