October 12th, 2010
Heart Failure and Resource Use at the End of the Road
Two studies of heart failure populations — one conducted in the U.S. and one in Canada — shed light on patterns of resource use in the last 6 months of life. Both studies appear in the Archives of Internal Medicine.
Kathleen Unroe and colleagues retrospectively analyzed resource use in a cohort of nearly 230,000 U.S. Medicare beneficiaries with heart failure who died between January 1, 2000 and December 31, 2007. Although patient use of hospice services increased over the course of the study, overall use of resources and costs also increased.
Padma Kaul and colleagues analyzed resource usage in some 33,000 elderly patients with heart failure who died between January 1, 2000 and December 31, 2006 in Alberta, Canada. Although costs for the patients continued to increase during the study, the number of hospitalizations and in-hospital deaths decreased and the use of outpatients services increased.
In an accompanying editorial, Rosemary Gibson notes that the two studies were unable to answer whether the patients received appropriate care. She writes that “conversations that allow the patient to describe what is important as he or she lives life with serious illness or near life’s end should be paramount in guiding the course of treatment.”