National trends and disparities in place of death of heart failure-related mortality among older adults in the United States, 1999 to 2022

BACKGROUND: The purpose of this study is to analyze trends and disparities in the place of death of older adults with heart failure (HF) across the United States (US) from 1999 to 2022. METHODS: We used the US multiple cause-of-death files from CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access HF-related deaths among individuals aged ≥ 65 from 1999 to 2022. Deaths were categorized at home/hospice facilities, medical facilities, and nursing homes, and stratified into different demographic and geographic groups. Statistically significant trends in mortality over time were identified using Joinpoint regression model. RESULTS: From 1999 to 2022, there were 6,767,325 HF-related deaths. Of these, 2,124,398 (30.04 %) deaths occurred in home/hospice facilities, 2,627,426 (37.15 %) deaths occurred in medical facilities, and 2,015,501 (28.50 %) deaths occurred in nursing homes. The proportion of HF deaths increased in home/hospice facilities (AAPC 3.93*, CI: 3.76 - 4.14) while decreasing in medical facilities (AAPC -1.70*, CI: -1.79 to -1.61) and nursing homes (AAPC -2.07*, CI: -2.33 to -1.88) in all race/ethnic groups, US census regions and rural-urban areas. Hispanics had the highest proportion of deaths in home/hospice, while NH African Americans had the lowest. West and South regions continued to have high mortality in home/hospice, while the Midwest continued to have the highest mortality in nursing homes. CONCLUSIONS: A significant shift was seen in the place of death amongst older adults with HF, with an increase in the proportion of HF deaths occurring in home/hospice facilities and a decrease at medical facilities and nursing homes.