Resource Utilization For Medicare Beneficiaries With Heart Failure At The End Of Life

• Published in: Journal of cardiac failure 2024-01, Vol.30 (1), p.304-304
• Main Authors: McLeod, Kaitlyn, Thielen, Samantha, Mosley, Bridget, Sevick, Carter, Khazanie, Prateeti
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.446

Approaching end of life (EOL) care for patients with heart failure (HF) is nuanced. Preferences around EOL care have been shown to fluctuate over the course of illness. This has implications for resource utilization and cost to the healthcare system at the EOL, particularly in matters of recurrent hospitalization and decision to pursue home therapies. HF is increasingly prevalent among medicare beneficiaries and associated hospitalizations, procedures, and symptom management contribute to high costs at the EOL. Prior cohort studies have evaluated medicare beneficiaries with HF at the EOL and demonstrated a trend toward increased days in ICU and cost, but also increased use of hospice services. We seek to describe the costs, predictors of cost, and general use of health care resources in the final 6 months of life for medicare beneficiaries with HF who died in 2017-2018 using 100% Medicare data. Understanding this landscape can guide future policy and resource allocation to better align the health system needs with patient preferences. Descriptive statistics were performed on 977,138 Medicare beneficiaries with HF who died between July 1, 2017- December 31, 2018. Prevalence of common comorbidities for HF were identified. We evaluated all-cause hospitalizations, skilled nursing facility stays, hospice benefit use, home health care use, durable medical equipment, outpatient physician visits, emergency department visits, cardiac procedures and dialysis. Relative cost ratios for total costs of all above listed Medicare services were modeled in multivariate analysis. There were 977,138 Medicare beneficiaries with HF who died between July 1, 2017-December 31, 2018. The mean age was 80.9 years, and 51% were female. 52.9% carried a diagnosis of HFrEF, and 59.8% had ischemic heart disease. Comorbidities like hypertension, diabetes, peripheral vascular disease, cerebrovascular disease, COPD, and renal disease were common. At least one comorbidity was present in 80.7% of patients. In the last 6 months of life, 81.2% of patients had an all-cause hospitalization. The average ICU stay was 9.2 days, and 30.8% died in inpatient care. Still, 47.8% of patients utilized hospice care, and 32.2% of patients died in hospice care. The most common tests and procedures were echocardiograms (58%), cardiac catheterization (7.9%) and dialysis (7.8%). This care translated to a mean total cost of 39,340 dollars per patient. Adjusted relative cost ratios showed lower costs for older pati