medwireNews: End-stage heart failure patients enter hospice care closer to the time of their death, are more often referred from acute care facilities, and are more likely to die in acute care settings compared with cancer patients, show study results.
Several factors may explain the difference in hospice use between the two patient groups, writes the team in the Journal of Pain and Symptom Management, with one being that physicians may be less able to recognize the prognosis of end-stage heart failure because the trajectory of the condition is unpredictable.
Furthermore, "the acceptance of palliative care and hospice use in cardiology has not been studied, and may be less than that of oncology... [which] has traditionally placed a significant emphasis on symptom palliation as a routine part of comprehensive care," say Winston Cheung (British Columbia Cancer Agency, Vancouver, Canada) and colleagues.
The team used data from the Pharmaceutical Assistance Contract for the Elderly program from 1997 through 2004 to identify 1580 and 3840 heart failure and cancer patients, respectively, who were admitted to hospice at least once before their deaths.
Patients with heart failure were a significant 1.49 times more likely to enter hospice care late in their disease course (within 7 days of death) compared with cancer patients, report Cheung et al. They were also significantly more likely to be discharged from hospice before death (odds ratio [OR]=1.11) and use acute care after hospice (OR=1.46) than their counterparts with cancer.
While cancer patients were significantly more frequently admitted from home, at 67% compared with 53% of heart failure patients, that latter group was significantly more frequently referred from acute care hospitals or nursing homes, at 35% versus 24%, and 9% versus 7%, respectively.
Indeed, compared with patients referred from home, those referred from either acute care or nursing homes were significantly more likely to be enrolled late, at ORs of 1.81 and 1.84, respectively.
The reason for the difference in the source of referrals between these two sets of patients is unclear, remark the authors, who suggest that they may reflect the lack of coordination among outpatient palliative care services for heart failure patients.
"Future work should evaluate whether educational interventions that emphasize the importance of hospice and supportive care programs can improve the rate of patient-initiated referrals for heart failure," the researchers conclude.
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