Resource Use in the Last 6 Months of Life Among Medicare Beneficiaries With Heart Failure, 2000-2007

Unroe, Kathleen T.; Greiner, Melissa A.; Hernandez, Adrian F.; Whellan, David J.; Kaul, Padma; Schulman, Kevin A.; Peterson, Eric D.; Curtis, Lesley H.

doi:10.1001/archinternmed.2010.371

Cited by 153 publications

(132 citation statements)

References 35 publications

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“…133 Despite the availability of hospice care, most patients dying of advanced CVD die in hospitals. 134 End-of-life care for patients with advanced CVD often involves decisions to stop or deactivate devices, including implantable cardioverter-defibrillators and VADs. Before deactivating cardiac devices, patients and family members need to understand the patient's condition and care options and have clear knowledge of what will happen if the device is stopped (eg, anticipated death).…”

Section: -131mentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

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AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

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Section: -131mentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

View full text Add to dashboard Cite

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“…2,[12][13][14][15] This seems logical, since persons with advanced HF and their families, like patients with cancer, bear the brunt of unaddressed physical pain and emotional suffering, face a number of complex and difficult medical decisions, 2 and weather multiple hospitalizations in their last year of life. 7,9,[16][17][18][19][20][21] Initiation of interdisciplinary palliative care services beginning early in the course of advanced HF has been strongly recommended as a critical strategy in addressing these challenges by professional groups 6,15,19,[25][26][27][28][29] including the AHA 25 and many others. 5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, patients receive an in-person PC team assessment based on National Consensus Project PC guidelines. 22 ENABLE [21][22][23] is the first successful PC intervention in the rural advanced cancer population to apply Wagner's Chronic Illness Care (CIC) model, [24][25][26][27][28][29][30] which shifted the cancer care paradigm by introducing concurrent PC earlier in the disease trajectory (see Fig. 3).…”

Section: Introductionmentioning

confidence: 99%

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

Dionne‐Odom

KonoAlan

FrostJennifer

et al. 2014

Journal of Palliative Medicine

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Background: Heart failure (HF) and palliative care (PC) organizations recommend early PC to improve the quality of life of patients living with HF. Objective: We conducted a two-phase formative evaluation study to translate a cancer-focused concurrent PC intervention into one that would be appropriate for rural-dwelling adults with New York Heart Association Class III-IV HF and their primary caregivers. Methods: Phase I: We tailored the intervention for an HF population via literature review, expert consultation, and clinician (N = 15) small group interviews. Phase II: We enrolled 11 patient/caregiver dyads to assess intervention feasibility and satisfaction. We assessed participants' experiences and satisfaction after session/ week three and session/week six via digitally recorded interviews. Clinician and participant interviews were transcribed and content analyzed. Outcome measures were evaluated for completion rates and effect sizes. Results: Phase I: Clinicians described barriers to initiating PC in HF, triggers for initiating PC, and suggestions for intervention improvement. Phase II: Participants were able to complete the majority of study sessions, measures, and interviews. Satisfaction interviews revealed the content to be relevant and comprehensive in addressing HF patient and caregiver primary concerns; however, participants unanimously suggested making the intervention available earlier in the illness trajectory. Efficacy measures demonstrated small to medium effect sizes. Conclusions:We tailored and demonstrated feasibility of providing an early, concurrent palliative care intervention to patients with advanced HF and their caregivers. Based on this experience we are now conducting an efficacy trial in a racially diverse sample.

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“…We and others have previously described the use of critical care beds in the last 6 months of life (a mean of 2 days during the 6 months). 12,13 Total, as well as critical care days, are a major driver for total costs of care for AHF, and AHF remains one of the most common causes for both admission and re-admission.…”

Section: Discussionmentioning

confidence: 99%

Acute Heart Failure

Ezekowitz

Delgado

et al. 2012

Circ: Heart Failure

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Background— Randomized controlled trials (RCT) are limited by their generalizability to the broader nontrial population. To provide a context for Acute Study of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial, we designed a complementary registry to characterize clinical characteristics, practice patterns, and in-hospital outcomes of acute heart failure patients. Methods and Results— Eligible patients for the registry included those with a principal diagnosis of acute heart failure (ICD-9-CM 402 and 428; ICD-10 I50.x, I11.0, I13.0, I13.2) from 8 sites participating in ASCEND-HF (n=697 patients, 2007–2010). Baseline characteristics, treatments, and hospital outcomes from the registy were compared with ASCEND-HF RCT patients from 31 Canadian sites (n=465, 2007–2010). Patients in the registry were older, more likely to be female, and have chronic respiratory disease, less likely to have diabetes mellitus: they had a similar incidence of ischemic HF, atrial fibrillation, and similar B-type natriuretic peptide levels. Registry patients had higher systolic blood pressure (registry: median 132 mm Hg [interquartile range 115–151 mm Hg]; RCT: median 120 mm Hg [interquartile range 110–135 mm Hg]) and ejection fraction (registry: median 40% [interquartile range 27–58%]; RCT: median 29% [interquartile range 20–40 mm Hg]) than RCT patients. Registry patients presented more often via ambulance and had a similar total length of stay as RCT patients. In-hospital mortality was significantly higher in the registry compared with the RCT patients (9.3% versus 1.3%, P <0.001), and this remained after multivariable adjustment (odds ratio 6.6, 95% CI 2.6–16.8, P <0.001). Conclusions— Patients enrolled in a large RCT of acute heart failure differed significantly based on clinical characteristics, treatments, and inpatient outcomes from contemporaneous patients participating in a registry. These results highlight the need for context of RCTs to evaluate generalizability of results and especially the need to improve clinical outcomes in acute heart failure. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00475852.

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Resource Use in the Last 6 Months of Life Among Medicare Beneficiaries With Heart Failure, 2000-2007

Abstract: Among Medicare beneficiaries with heart failure, health care resource use at the end of life increased over time with higher rates of intensive care and higher costs. However, the use of hospice services also increased markedly, representing a shift in patterns of care at the end of life.

Cited by 153 publications

References 35 publications

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

Acute Heart Failure

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