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75% of people with heart failure die in hospital, researchers find providing end-of-life care doubles likelihood of dying at home

February 20, 2020 Toronto

Three out of four adults with heart failure die in hospital and less than half receive palliative care in their last year of life, according to new research from ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues.

“People who received palliative care were more than twice as likely to die at home compared to those who did not receive palliative care. Previous research has shown us that up to 87 per cent of people want to die at home,” says Dr. Kieran Quinn, the lead author of the study, a physician at Sinai Health System and an ICES student.

Heart failure is a leading cause of death and hospitalization worldwide. Patients with heart failure are frequently readmitted to hospital nearing the end of their life, which contributes to worsening overall quality of life. Following hospital admission for heart failure, half of all patients will die within 2.5 years. 

The study, published today in the Journal of the American Heart Association, looked at data on 74,986 adults with chronic heart failure who died between 2010 and 2015. The researchers identified a significant gap in access to high-quality end-of-life care for these patients. They also showed that specific components of palliative care delivery lead to a higher probability of dying at home than others. These results suggest that expanding existing palliative care programs to increase access may improve end-of-life care in people dying with chronic noncancer illness such as heart failure.

“Our findings show that there is an important need to examine the role of end-of-life care in chronic noncancer illness like heart failure because current evidence shows that cancer patients receive the majority of palliative care,” says senior author Dr. Peter Tanuseputro, adjunct scientist at ICES, researcher at the Bruyère Research Institute, physician-scientist at The Ottawa Hospital and assistant professor at the University of Ottawa.

Palliative care focusses on the care of people who are suffering from serious illness with a goal of improving quality of life for them and their caregivers. Leading cardiovascular societies now recommend that patients with heart failure receive palliative care soon after being diagnosed, instead of at the end of life.

The key findings from the study:

  • 75 per cent of heart failure patients died in a hospital, much higher than the provincial average of about 50 per cent for cancer patients
  • Less than half of all patients (47.1 per cent) received palliative care – much lower than the number of patients with cancer (88 per cent) who receive it
  • People who received palliative care were more than twice as likely to die at home compared to those who did not receive palliative care
  • People who received palliative care in their home were 8 to 11 times more likely to die at home than those who only received palliative care in the hospital
  • Palliative care was often started less than 30 days prior to death, which is considered late

The study “Association Between Palliative Care and Death at Home in Adults with Heart Failure,” was published by the Journal of the American Heart Association (JAHA).

Author block: Kieran L. Quinn, Amy T. Hsu, Glenys Smith, Nathan Stall, Allan S. Detsky, Dio Kavalieratos, Douglas S. Lee, Chaim M. Bell and Peter Tanuseputro.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

FOR FURTHER INFORMATION PLEASE CONTACT:

Deborah Creatura
Media Advisor, ICES
deborah.creatura@ices.on.ca
(o) 416-480-4780 or (c) 647-406-5996


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