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End-of-Life Hospitalizations in Heart Failure
Study Questions:
What is the incidence and what are the causes of hospitalization in the year preceding death of patients with heart failure (HF)?
Methods:
The investigators identified patients who died in the period 2001–2016 after having experienced HF for at least 1 year from the Danish nationwide registries, and examined hospitalizations during the last year of life in age- and sex-stratified analyses. The primary outcome of interest was overnight hospital stays. The differences in study outcomes were tested with chi-square test. Time trends were tested with Cochran-Armitage trend test.
Results:
The authors included 32,157 patients. Median age at time of death was 81 years; 39% were women. A total of 26,561 (84%) patients were hospitalized at least once during the last year of life. The patients experienced a median of 2 (1-3) hospitalizations and spent 14 (3-31) days in the hospital. Of all hospitalizations (n = 80,362), 9,644 (12%) were due to HF, 14,738 (18%) due to other cardiovascular (CV) causes, and 51,696 (64%) due to non-CV causes (p < 0.001). The frequency of hospitalizations increased toward death, but the domination of non-CV causes remained consistent throughout the year, regardless of age and sex. If the authors included diagnoses covering renal insufficiency in the definition of HF hospitalizations, non-CV hospitalizations remained dominant (58%).
Conclusions:
The authors concluded that during the last year alive, patients with HF were more often hospitalized due to non-CV causes rather than HF.
Perspective:
This study reports that HF hospitalizations accounted for a minor part of the total burden of hospitalization, whereas non-CV hospitalizations were dominating during the last year of life in with patients with HF independently of age, sex, and comorbidity. Furthermore, during the last year of life, patients with HF are not frequently hospitalized until 2 months before death, where the burden of hospitalizations increases steeply. The fact that patients are primarily out of hospital until 2 months before death and that they are mostly hospitalized due to non-CV causes during the last year of life highlights the complexity of HF patient care and demonstrates the difficulty of optimal end-of-life care of these individuals by HF teams alone. There is a need for multidisciplinary collaboration between primary care physicians, internal medicine specialists, and specialized HF teams to optimally manage these individuals.
Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Comorbidity, Geriatrics, Heart Failure, Hospitalization, Length of Stay, Patient Readmission, Renal Insufficiency, Secondary Prevention, Terminal Care
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