title: Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer.
abstract: BACKGROUND
  Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF.
  
  
  METHODS
  Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities.
  
  
  RESULTS
  Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%).
  
  
  CONCLUSIONS
  Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. ssetoguchi@partners.org
authors.forename: Soko
authors.initials: S
authors.lastname: Setoguchi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: Margaret
authors.initials: M
authors.lastname: Stedman
authors.forename: Carol M
authors.initials: CM
authors.lastname: Flavell
authors.forename: Raisa
authors.initials: R
authors.lastname: Levin
authors.forename: Lynne Warner
authors.initials: LW
authors.lastname: Stevenson
mesh_terms: D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017051:Hospice Care / Q000458:organization & administration*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid