Abstract 3143: Hospice Enrollment and Duration for Patients With Heart Failure versus Cancer
Introduction: The development of hospice care for heart failure (HF) lags behind hospice care for cancer, and may be hindered by the less predictable trajectory of late-stage HF.
Hypothesis: Late referral to hospice, defined as death within 3 days, is more common for HF patients (pts) than cancer pts.
Methods: Two end-of-life cohorts (HF and cancer) were identified using Medicare data (1997–2005). The HF cohort consisted of pts with 2 HF hospitalizations before cardiac death. The cancer cohort had 1 of 4 registry-defined common solid tumors and death attributed to cancer. We compared referral patterns and clinical courses in the 2 cohorts.
Results: Among 7,930 HF with mean age of 81, 20% were enrolled in hospice compared to 51% in 7,565 cancer pts. (p<0.01). Enrollments from acute care settings were more common in HF pts compared to cancer pts (38% vs. 26%). While the overall percentage was small, death in acute care settings was twice as common in HF pts (4% vs. 2%, p<0.01). ER visits or hospitalizations after hospice enrollment were more frequent in HF (Table⇓). More HF pts were discharged from hospice prior to death (10% vs. 8%, p=0.03). Among pts remaining in hospice, enrollment in hospice within 3 days of death was more common in HF pts (20% vs.11%, p <0.01), while death within 180 days after hospice enrollment was similar in HF vs. cancer pts (95% vs. 96%, p=0.3).
Conclusion: In the large sample of contemporary elderly pts, those dying with HF were referred to hospice less often than pts with cancer, perhaps reflecting reliance upon in-hospital screening for referral. This, along with the variable trajectory of their clinical course, may account for late enrollment of HF pts and higher use of acute care services after hospice referral. Nevertheless, most pts remained and died in hospice within 6 months. The concept of hospice has been successfully translated from cancer to HF, but hospice could be made more accessible to HF pts, particularly in the outpatient setting.