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Enrollment and events of hospice patients with heart failure vs. cancer.
J Pain Symptom Manage. 2013 Mar; 45(3):552-60.JP

Abstract

CONTEXT

Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure.

OBJECTIVES

We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer.

METHODS

Using Medicare data linked with pharmacy and cancer registry data, we identified patients who were diagnosed with either heart failure or advanced cancer between 1997 and 2004, admitted to hospice at least once after their diagnosis, and died during the study period. We compared patterns of referral, use of acute services, and site of death of hospice patients with heart failure with those of patients with advanced cancer. Logistic regression models were constructed to determine the factors associated with late hospice enrollment as well as the use of and death in acute care.

RESULTS

We identified 1580 heart failure patients and 3840 advanced cancer patients: mean ages were 86 and 80 years, 82% and 68% were women, and 97% and 94% were white, respectively. Compared with patients with advanced cancer, those with heart failure were more frequently referred to hospice from hospitals (35% vs. 24%) and nursing facilities (9% vs. 7%) (both P<0.01). Discharge from hospice before death was similar for patients with heart failure and patients with advanced cancer (10% vs. 9%, P=0.03). Among patients remaining in hospice, patients with heart failure were more likely to have been enrolled within three days of death (20% vs.11%, P<0.01). The prevalence of death in acute care settings was low in both groups after hospice enrollment (4% heart failure vs. 2% advanced cancer, P<0.01). Although the median interval between enrollment and death was shorter for heart failure patients (12 vs. 20 days, P<0.001), emergency department visits and hospitalizations after hospice enrollment were more frequent in patients with heart failure (13% vs. 10% and 9% vs. 6%, respectively, both P<0.01).

CONCLUSION

Compared with patients with advanced cancer, referral to hospice is more often initiated during acute care encounters for patients with end-stage heart failure, who also more frequently return to acute care settings even after hospice enrollment.

Authors+Show Affiliations

Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. wcheung@bccancer.bc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22940560

Citation

Cheung, Winson Y., et al. "Enrollment and Events of Hospice Patients With Heart Failure Vs. Cancer." Journal of Pain and Symptom Management, vol. 45, no. 3, 2013, pp. 552-60.
Cheung WY, Schaefer K, May CW, et al. Enrollment and events of hospice patients with heart failure vs. cancer. J Pain Symptom Manage. 2013;45(3):552-60.
Cheung, W. Y., Schaefer, K., May, C. W., Glynn, R. J., Curtis, L. H., Stevenson, L. W., & Setoguchi, S. (2013). Enrollment and events of hospice patients with heart failure vs. cancer. Journal of Pain and Symptom Management, 45(3), 552-60. https://doi.org/10.1016/j.jpainsymman.2012.03.006
Cheung WY, et al. Enrollment and Events of Hospice Patients With Heart Failure Vs. Cancer. J Pain Symptom Manage. 2013;45(3):552-60. PubMed PMID: 22940560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enrollment and events of hospice patients with heart failure vs. cancer. AU - Cheung,Winson Y, AU - Schaefer,Kristen, AU - May,Christopher W, AU - Glynn,Robert J, AU - Curtis,Lesley H, AU - Stevenson,Lynne W, AU - Setoguchi,Soko, Y1 - 2012/08/30/ PY - 2011/11/30/received PY - 2012/03/12/revised PY - 2012/03/13/accepted PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/12/16/medline SP - 552 EP - 60 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 45 IS - 3 N2 - CONTEXT: Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure. OBJECTIVES: We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer. METHODS: Using Medicare data linked with pharmacy and cancer registry data, we identified patients who were diagnosed with either heart failure or advanced cancer between 1997 and 2004, admitted to hospice at least once after their diagnosis, and died during the study period. We compared patterns of referral, use of acute services, and site of death of hospice patients with heart failure with those of patients with advanced cancer. Logistic regression models were constructed to determine the factors associated with late hospice enrollment as well as the use of and death in acute care. RESULTS: We identified 1580 heart failure patients and 3840 advanced cancer patients: mean ages were 86 and 80 years, 82% and 68% were women, and 97% and 94% were white, respectively. Compared with patients with advanced cancer, those with heart failure were more frequently referred to hospice from hospitals (35% vs. 24%) and nursing facilities (9% vs. 7%) (both P<0.01). Discharge from hospice before death was similar for patients with heart failure and patients with advanced cancer (10% vs. 9%, P=0.03). Among patients remaining in hospice, patients with heart failure were more likely to have been enrolled within three days of death (20% vs.11%, P<0.01). The prevalence of death in acute care settings was low in both groups after hospice enrollment (4% heart failure vs. 2% advanced cancer, P<0.01). Although the median interval between enrollment and death was shorter for heart failure patients (12 vs. 20 days, P<0.001), emergency department visits and hospitalizations after hospice enrollment were more frequent in patients with heart failure (13% vs. 10% and 9% vs. 6%, respectively, both P<0.01). CONCLUSION: Compared with patients with advanced cancer, referral to hospice is more often initiated during acute care encounters for patients with end-stage heart failure, who also more frequently return to acute care settings even after hospice enrollment. SN - 1873-6513 UR - https://www.unboundmedicine.com/medline/citation/22940560/Enrollment_and_events_of_hospice_patients_with_heart_failure_vs__cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(12)00293-X DB - PRIME DP - Unbound Medicine ER -