Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients: Results From the NCDR®
Background—Older recipients of ICDs are at increased risk for short-term mortality compared with younger patients. Though hospice use is common among decedents aged > 65, its utilization among older ICD recipients is unknown.
Methods and Results—Medicare patients aged > 65 matched to data in the National Cardiovascular Data Registry - ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N = 194,969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Over 5 years, 52,990 (27.1%) patients died and 22,336 (11.5%) were enrolled in hospice. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval (CI), 4.6% - 4.8%) within 1 year and 21.3% (95% CI, 20.7% - 21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were: older age (adjusted hazard ratio (AHR) 1.79, 95% CI 1.75-1.83), Class IV heart failure (versus Class I) (AHR 1.76, 95% CI 1.63 - 1.91); ejection fraction < 20 (AHR, 1.56, 95% CI 1.47 - 1.67) and greater hospice use among decedents in the patients' health referral region.
Conclusions—Over one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus.
- implantable cardioverter-defibrillator
- health outcomes
- health services research
- congestive heart failure
- Received December 1, 2015.
- Revision received March 15, 2016.
- Accepted March 23, 2016.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.