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Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer.
Am Heart J. 2010 Jul; 160(1):139-44.AH

Abstract

BACKGROUND

Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF.

METHODS

Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities.

RESULTS

Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%).

CONCLUSION

Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients.

Authors+Show Affiliations

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. ssetoguchi@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20598984

Citation

Setoguchi, Soko, et al. "Hospice, Opiates, and Acute Care Service Use Among the Elderly Before Death From Heart Failure or Cancer." American Heart Journal, vol. 160, no. 1, 2010, pp. 139-44.
Setoguchi S, Glynn RJ, Stedman M, et al. Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer. Am Heart J. 2010;160(1):139-44.
Setoguchi, S., Glynn, R. J., Stedman, M., Flavell, C. M., Levin, R., & Stevenson, L. W. (2010). Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer. American Heart Journal, 160(1), 139-44. https://doi.org/10.1016/j.ahj.2010.03.038
Setoguchi S, et al. Hospice, Opiates, and Acute Care Service Use Among the Elderly Before Death From Heart Failure or Cancer. Am Heart J. 2010;160(1):139-44. PubMed PMID: 20598984.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer. AU - Setoguchi,Soko, AU - Glynn,Robert J, AU - Stedman,Margaret, AU - Flavell,Carol M, AU - Levin,Raisa, AU - Stevenson,Lynne Warner, PY - 2009/10/06/received PY - 2010/03/27/accepted PY - 2010/7/6/entrez PY - 2010/7/6/pubmed PY - 2010/8/18/medline SP - 139 EP - 44 JF - American heart journal JO - Am Heart J VL - 160 IS - 1 N2 - BACKGROUND: Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF. METHODS: Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities. RESULTS: Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%). CONCLUSION: Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20598984/Hospice_opiates_and_acute_care_service_use_among_the_elderly_before_death_from_heart_failure_or_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00316-9 DB - PRIME DP - Unbound Medicine ER -