Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home‐Based Palliative Care

Campos, Erin; Isenberg, Sarina R.; Lovblom, Leif E.; Mak, Susanna; Steinberg, Leah; Bush, Shirley H.; Goldman, Russell; Graham, Caroline; Kavalieratos, Dio; Stukel, Thérèse A.; Tanuseputro, Peter; Quinn, Kieran L.

doi:10.1161/jaha.122.026319

Cited by 6 publications

(1 citation statement)

References 40 publications

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“…Many patients in the palliative care group of the study were still actively pursuing treatment. The research team has also shown 2 evolving care preferences among patients with heart failure, with about half of those initially seeking active care shifting to a more comfort-based approach as their condition progressed.…”

Section: Barriers To Carementioning

confidence: 99%

Collaborative Care Model Helps Patients With Heart Failure Meet End-of-Life Goals

Kuehn¹

2023

Circulation

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Section: Barriers To Carementioning

confidence: 99%

Collaborative Care Model Helps Patients With Heart Failure Meet End-of-Life Goals

Kuehn¹

2023

Circulation

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Heart failure treatment in the last years of life: A nationwide study of 364 000 individuals

Sundström,

Gustafsson,

Cars

et al. 2024

European J of Heart Fail

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AimsIn patients with heart failure, treatment patterns in the last years of life have not been assessed at large scale. We aimed to assess whether heart failure treatment patterns up to 5 years prior to death changed over time.Methods and resultsIn a cohort study covering the whole Swedish population, we assessed all heart failure patients who died between 1 July 2007 and 31 December 2020 for evidence‐based treatments. The proportion on the respective treatment at the time of death was examined by year of death using binomial regression. Looking back in time, treatment discontinuation rates were estimated using Poisson regression on time‐split data. Combining these models, the proportion on each medication was estimated up to 5 years prior to death. A total of 364 480 patients died with heart failure during the study period. Half were women, and the median (interquartile range) age at death was 86 (79–90). The use of all heart failure treatments decreased gradually closer to death, but the discontinuation rate of beta blockers decreased over time, resulting in an increasing proportion of patients on treatment at the time of death.ConclusionIn patients with heart failure, a changing pattern of medical treatment during the last years of life was observed, most notably with an increasing use of beta blockers. This may in part be due to a changing pattern of comorbidities over time, with an increase in e.g. hypertension and atrial fibrillation, but a decline in ischaemic heart disease.

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Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure

Bose Brill,

Riley,

Prater

et al. 2024

J GEN INTERN MED

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Background Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice. Objective Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life. Design This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020. Participants A total of 48,466 deceased patients diagnosed with heart failure on Medicare. Main Measures Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services. Key Results In the final cohort of 48,466 patients (median [IQR] age, 83 [76–89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2–5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77–0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47–2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24–1.42) compared with patients without a billed advance care planning encounter. Conclusions Billed advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice.

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Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home‐Based Palliative Care

Cited by 6 publications

References 40 publications

Collaborative Care Model Helps Patients With Heart Failure Meet End-of-Life Goals

Collaborative Care Model Helps Patients With Heart Failure Meet End-of-Life Goals

Heart failure treatment in the last years of life: A nationwide study of 364 000 individuals

Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure

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