Trends in Place of Death for Cardiovascular Mortality Related to Heart Failure in the United States From 2003 to 2017

Abstract

Background: The location of death is an important component of end-of-life care. However, contemporary trends in the location of death for cardiovascular deaths related to heart failure (CV-HF) and comparison to cancer deaths have not been fully examined. Methods: We analyzed data from the Centers for Disease Control and Prevention’s Control Wide-Ranging Online Data for Epidemiologic Research database between 2003 and 2017 to identify location of death for CV-HF and cancer deaths. The proportions of deaths that occurred in a hospice facility, home, and medical facility were tested for trends using linear regression. Odds ratios were calculated to determine the odds of death occurring in a hospice facility or home (versus a medical facility) stratified by sex and race. Results: We identified 2 940 920 CV-HF and 8 852 066 cancer deaths. Increases were noted in the proportion of CV-HF deaths in hospice facilities (0.2% to 8.2%; P trend <0.001) and at home (20.6% to 30.7%; P trend <0.001), whereas decreases were noted in the proportion of deaths in medical facilities (44.5% to 31.0%; P trend <0.001) and nursing homes (30.8% to 25.7%; P trend <0.001). The odds of dying in a hospice facility (odds ratio, 1.79 [1.75–1.82]) or at home (odds ratio, 1.55 [1.53–1.56]) versus a medical facility was higher for whites versus blacks. The rate of increase in proportion of deaths in hospice facilities was higher for cancer deaths (β=1.05 [95% CI, 0.97–1.12]) than for CV-HF deaths (β=0.61 [95% CI, 0.58–0.64]). Conclusions: The proportion of CV-HF deaths occurring in hospice facilities is increasing but remains low. Disparities are noted whereby whites are more likely to die in hospice facilities or at home versus medical facilities compared with blacks. More research is needed to determine end-of-life preferences for patients with HF and identify the basis for these differences in location of death.

Challenges for Patients Dying of Heart Failure and Cancer

“…These data build on previous studies that demonstrate the differences between patients dying of cancer and heart failure. Our study confirms previous findings that patients with HF are more likely to die in a medical facility such as a hospital or nursing home rather than at home or in hospice, 6,7 are more likely to have functional limitations and are less likely to use hospice. 8,9 This complexity of disease and function has direct implications for prognostication and care coordination.…”

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

“…In the study examining deaths due to heart failure between 2003 and 2017 in USA, hospital deaths have been observed to decrease as years progressed. 26 Among the reasons for this condition include the preference of patients to die at home as well as being able to receive inotropic infusion support as home care service during terminal periods. 27 In Turkey, by improving home care services and increasing support in nursing homes, it can also be ensured for these patients to live without spending their terminal periods in the hospital.…”

Distribution in Place of Death for COVID‐19–Related Mortality in the United States

“…Although recent work has demonstrated that U.S. deaths in medical facilities are decreasing and deaths at home and in hospice facilities are increasing, the burden of deaths attributed to COVID-19 may reverse these overall trends. 3,4 Limitations of these data include reliance on provisional death certificate data for cause and location of death. Further, significant excess mortality not attributed to COVID-19 during this time period has also been reported, 5 but the location of these deaths or their influence on place of death proportions is not yet known.…”