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End-of-life care patterns shift for patients with heart failure in both US and Canada
Date:10/11/2010

Health care in the last six months of life has become progressively more expensive for patients with heart failure both among Medicare beneficiaries in the United States and older adults in Canada, with a high rate of hospitalizations in the final six months of life in both countries, according to two reports posted online today that will be published in the February 14 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A third report finds that more men dying of prostate cancer are receiving hospice care, but that the timing of hospice referral remains poor.

Heart failure is a common cause of death in both the United States and Canada, according to background information in the articles. The condition is listed on one in eight death certificates in the United States, and the five-year death rate among those hospitalized with heart failure is about 70 percent. "Provision of high-quality health care at the end of life poses challenges for both health care providers and policy makers," the authors write. "End-of-life care has many dimensions, including patient preferences and values, health care provider practices and concerns about the appropriate use of resources. Although most patients prefer to die at home, many die in hospitals or nursing homes. The cost of health care at the end of life is also substantial. More than one-quarter of Medicare spending occurs in the last year of life, a figure that has remained stable for several decades."

In one article, Kathleen T. Unroe, M.D., M.H.A., of Duke Clinical Research Institute, Durham, N.C., and colleagues studied 229,543 Medicare beneficiaries with heart failure who died between 2000 and 2007. They examined resource use in the last six months of life and calculated costs to Medicare.

Over the entire study period, about 80 percent of patients were hospitalized in the last six months of life. Between 2000 and 2007, days in the intensive care unit incre
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Contact: Melissa Schwarting
melissa.schwarting@duke.edu
919-660-1303
JAMA and Archives Journals
Source:Eurekalert

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