Resource Use in the Last 6 Months of Life Among Patients With Heart Failure in Canada

BACKGROUND: Heart failure (HF) is a debilitating and chronic condition associated with significant morbidity and mortality. However, much less is known about end-of-life (EOL) costs among patients with HF. METHODS: To examine trends in resource use and costs during the last 6 months of life among elderly patients with HF, we evaluated data regarding all patients 65 years or older with HF who died between January 1, 2000, to December 31, 2006, in Alberta, Canada, and examined costs associated with all-cause hospitalizations, intensive care, emergency department visits, outpatient visits, physician office visits, and outpatient drugs in the 180 days before death. Overall costs and predictors of costs to the health care system were also examined. RESULTS: The study population included 33, 144 patients with HF who died. The mean age at death was 83 years. The clinical profile of patients changed during the study period, with an increasing comorbidity burden over time. Between 2000 and 2006, the percentage of patients hospitalized during the last 6 months of life decreased from 84% to 76% (P<. 01) ; and the percentage dying in hospital decreased from 60% to 54% (P<. 01). In 2006, the average EOL cost was 27, 983 in Canadian dollars. In multivariate analyses, increasing age was inversely associated with EOL costs and comorbid conditions were associated with higher costs. CONCLUSIONS: Resource use in the last 6 months of life among patients with HF in Alberta is changing, with a reduction in hospitalizations, in-hospital deaths, and an increase in the use of outpatient services. However, EOL costs are substantial and continue to increase.