Hospice use among patients with heart failure

Background Hospices provide end-of-life care for heart failure (HF) patients, but hospice is underused for these patients, and its use has not been well described. Methods We examined hospice use among 11,754 HF and 31,228 cancer patients. These patients were either discharged from hospice or died while in hospice between January 1, 2004, and June 30, 2005. Results The percentages of patients with HF and cancer who received hospice care for <= 7 days were similar (31.7% vs 30.8%; P = .08), but HF patients were significantly more likely to receive hospice care for >= 6 months (7.6% vs 1.1%; P < .001). Patients with HF were significantly more likely to be discharged from hospice alive (19.0% vs 11.3%; P < .001), as were African Americans with HF and those who were prescribed HF medications. Conclusion Our study provides detailed estimates of hospice use and identifies potential areas of hospice care that are unique to HF patients. Our findings generate hypotheses about the Medicare Hospice Benefit, specifically whether changes to the 6-month prognosis criterion for hospice eligibility would result in increased hospice use for HF patients. We hope that our results will stimulate additional studies to elucidate differences in hospice use between HF and cancer patients, including patient perspectives of hospice care and clinician referral patterns. (Am Heart J 2009; 158:118-25.)