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

ased from 3.5 to 4.6, hospice use increased from 19 percent to nearly 40 percent of patients and unadjusted average costs to Medicare per patient increased 26 percent from $28,766 to $36,216. After adjusting for age, sex, race, co-occurring medical conditions and region, costs increased by 11 percent. Older patients tended to have lower costs, while those with kidney disease, lung disease or who were black were more likely to have higher costs.

The trend of increasing hospice use marks a substantial change in end-of-life care, the authors note. "Some studies have found hospice care to be more cost-effective than nonhospice care, but we did not observe lower use of other services as the use of hospice increased," they write. "Rates of inpatient hospitalization remained high, suggesting that the potential for hospice to prevent costly hospitalizations has yet to be fully realized."

In another article, Padma Kaul, Ph.D., of the University of Alberta, Edmonton, Alberta, Canada, and colleagues evaluated data from 33,144 patients in Canada who died of heart failure between 2000 and 2006. They also assessed resource use in the last six months of life along with costs to the national health care system, as Canada has a single-payer system with universal access.

The percentage of patients who were hospitalized during the last six months of life decreased over the study period, from 84 percent to 76 percent, as did the percentage of patients dying in the hospital (from 60 percent to 54 percent). However, patients who died in later years were substantially more likely to receive outpatient care in the last six months of life (52.8 percent in 2000 vs. 69.8 percent in 2006), and the average number of visits among those receiving such care increased from 6.4 to 7.7.

In 2006, the average end-of-life cost was $27,983 in Canadian dollars. "Costs in the last six months of life among patients who died in hospital were more than double those for pati
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Contact: Melissa Schwarting
melissa.schwarting@duke.edu
919-660-1303
JAMA and Archives Journals
Source:Eurekalert

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