Circulation: Heart Failure HHF Care in the Last Year of Life for Community Patients with Heart Failure Dunlay et al: End of Life Care in Heart Failure CIRCHF/2014/001826 CIRCHF/2014/001826 10.1161/CIRCHEARTFAILURE.114.001826 8 05/19/15 3 Picillo Emily 617-542-5100 617-542-6539 Udelson, James Tufts Medical Center Dr. Shannon Dunlay dunlay.shannon@mayo.edu Dr. Mayo Clinic, Rochester, MN Mayo Clinic, 200 First St. S.W Rochester Minnesota 55905 UNITED STATES 507-284-8087 507-266-7929 62167 Shannon Dunlay Mayo Clinic, Rochester, MN dunlay.shannon@mayo.edu 62167 Margaret M. Redfield Mayo Clinic and Foundation redfield.margaret@mayo.edu 15050 Ruoxiang Jiang Mayo Clinic jiang.ruoxiang@mayo.edu 105223 Susan Weston Mayo Clinic, Rochester, MN weston.susan@mayo.edu 101927 Véronique L. Roger Mayo Clinic roger.veronique@mayo.edu 5354 10/02/2014 10/02/2014 03/13/2015 03/19/2015 04/01/2015 05/19/2015 Original Articles health care utilization skilled nursing facility <p><b><i>Background</i></b>—Health care utilization peaks at the end-of-life (EOL) in patients with heart failure (HF). However, it is unclear what factors impact EOL utilization in patients with HF and if utilization has changed over time. </p><p><b><i>Methods and Results</i></b>—Southeastern Minnesota residents with HF were prospectively enrolled into a longitudinal cohort study from 2003-2011. Patients who died before December 31, 2012 were included in the analysis. Information on hospitalizations and outpatient visits in the last year of life was obtained using administrative sources. Negative binomial regression was used to assess the association between patient characteristics and utilization. The 698 decedents (47.3% men, 53.4% preserved ejection fraction [EF]) experienced 1528 hospitalizations (median 2 per person, range 0-12, 37.6% due to cardiovascular causes) and 12,927 outpatient visits (median 14 per person, range 0-119) in their last year of life. Most patients (81.5%) were hospitalized at least once and 28.4% died in the hospital. Patients who were older and those with dementia had lower utilization. Patients who were married, resided in a skilled nursing facility, and had more comorbidities had higher utilization. Patients with preserved EF had higher rates of non-cardiovascular hospitalizations though other utilization was similar. Over time, rates of hospitalizations and outpatient visits decreased, while palliative care consults and enrollment in hospice increased. </p><p><b><i>Conclusions</i></b>—While patient factors remain associated with differential health care utilization at the EOL, utilization declined over time and use of palliative care services increased. These results are encouraging given the high resource use in patients with HF.</p> 3 2 0 2 4 no yes CircHF_CIRCHF-2014-001826.xml CircHF_CIRCHF-2014-001826_file1.docx Commentary_EOL.docx

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CircHF_CIRCHF-2014-001826_merge.pdf CircHF_CIRCHF-2014-001826_Roger_5354_disclosure.pdf CircHF_CIRCHF-2014-001826_Roger_5354_copyright.pdf CircHF_CIRCHF-2014-001826_Dunlay_62167_disclosure.pdf CircHF_CIRCHF-2014-001826_Dunlay_62167_copyright.pdf CircHF_CIRCHF-2014-001826_Redfield_15050_disclosure.pdf CircHF_CIRCHF-2014-001826_Redfield_15050_copyright.pdf CircHF_CIRCHF-2014-001826_Weston_101927_disclosure.pdf CircHF_CIRCHF-2014-001826_Weston_101927_copyright.pdf CircHF_CIRCHF-2014-001826_Jiang_105223_disclosure.pdf CircHF_CIRCHF-2014-001826_Jiang_105223_copyright.pdf Please charge authors $70 per page MS has clinical perspective Please set the flag 'exportcadmusahafundingtypecodes' with the funding type code of the sources you wish to list. Subject Codes: [100] Health policy and outcome research [8] Epidemiology [110] Congestive epicillo