-- Robert Preidt
MONDAY, Oct. 11 (HealthDay News) -- End-of-life care for heart
failure patients is becoming more expensive, but hospice and
outpatient services show potential for reducing those costs,
American and Canadian researchers report.
In one study, a team at the Duke Clinical Research Institute in
Durham, N.C., analyzed data from 229,543 Medicare beneficiaries
with heart failure who died between 2000 and 2007. About 80 percent
of the patients were hospitalized in their last six months of
Between 2000 and 2007, the average number of days that heart
failure patients spent in an intensive care unit increased from 3.5
to 4.6 and hospice use increased from 19 percent to nearly 40
percent of patients. The unadjusted average cost to Medicare per
patient increased 26 percent, from $28,766 to $36,216. After the
researchers adjusted for age, sex, race, co-occurring medical
conditions and regional variations, the cost increase was 11
Patients with kidney disease and lung disease, as well as black
patients, tended to have higher costs, while older patients were
more likely to have lower costs.
The increased use of hospice care marks a substantial shift in
end-of-life care for patients with heart failure, which is
responsible for one of every eight deaths in the United States, the
"Some studies have found hospice care to be more cost-effective than non-hospice care, but we did not observe lower use of other services as the use of hospice increased," they wrote. "Rates of inpatient hospitalization remained high, suggesting that the potential for hospice to prevent costly hospitalization has yet to be fully realized."
In the second study, University of Alberta researchers analyzed
data from 33,144 heart failure patients in Canada who died between
2000 and 2006. During that time, there was a decrease in the rate
of hospitalization during the last six months of life (from 84
percent to 76 percent) and in the rate of in-hospital deaths (60
percent to 54 percent).
At the same time, there was an increase in the number of
patients who received outpatient care in the last six months of
life (52.8 percent to 69.8 percent) and in the average number of
visits among those receiving outpatient care (6.4 percent to 7.7
In 2006, the average cost of end-of-life care for a heart
failure patient was $27,983 in Canadian dollars. The average cost
of care during the last six months of life for patients who died in
hospital was more than double that of patients who died elsewhere
-- $38,279 vs. $15,905.
"The substantial impact of location of death on costs can be illustrated as follows: reducing the number of hospital deaths by 10 percent in 2006 would have saved the health care system approximately $11 million (486 patients multiplied by mean cost savings of $22,374 per patient)," the researchers wrote.
"Increasing the availability of alternative venues of care, such as long-term care and home care, may be effective in further reducing hospitalizations and containing costs," they concluded.
The studies appear online Oct. 11 in the
Archives of Internal Medicine.
The American Heart Association has more about
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