Resource use increased among Medicare beneficiaries with HF at end of life

Unroe K. Arch Intern Med. 2011;171:196-203.

Issue: April 2011

During the last 6 months of life, days of intensive care, hospice use and cost all increased for Medicare beneficiaries with HF during an 8-year period, according to findings from the Archives of Internal Medicine.

“Heart failure is listed on one in eight death certificates in the United States. Although some people live with HF for years, more than one-quarter of Medicare beneficiaries die within 1 year of the incident diagnosis, and 36% die within 1 year of a HF–related hospitalization,” the researchers wrote. “In this longitudinal analysis … we found that most patients [with HF] frequently accessed the health care system and spent some time in the hospital.”

The retrospective cohort study featured 229,543 Medicare beneficiaries with HF who died from 2000 to 2007. Investigators analyzed the beneficiaries’ resource use during the last 180 days of life, including all-cause hospitalizations, hospice, home health, ICU days, skilled nursing facility stays, durable medical equipment, outpatient physician visits and cardiac procedures.

Throughout the study period, about 80% of beneficiaries were hospitalized in the last 6 months of life. Investigators found that days in intensive care rose (3.5 to 4.6; P<.001), as did use of hospice (19% to 40%; P<.001) and unadjusted mean cost per beneficiary (26% increase; $28,766 to $36,216; P<.001).

When age, race, sex, geographic region and comorbid conditions were adjusted for, cost still increased by 11%. Renal disease, black race and chronic obstructive pulmonary disease were each independent predictors of higher costs, whereas increasing age was a strong independent factor for lower costs. Additionally, regional differences remained after adjustment, with higher costs of care found in the Northeast and West vs. the South.

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