TY - JOUR

T1 - Burden and Causes of Hospital Admissions in Heart Failure During the Last Year of Life

AU - Madelaire, Christian

AU - Gustafsson, Finn

AU - Kristensen, Søren L.

AU - D'Souza, Maria

AU - Stevenson, Lynne W.

AU - Kober, Lars

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Schou, Morten

PY - 2019/7

Y1 - 2019/7

N2 - Objectives: This study aimed to evaluate the incidence and causes of hospitalization in the year preceding death of patients with heart failure (HF). Background: Hospitalizations in HF are common, especially in the last period of the lives of patients with HF, but little is known about hospitalization burden and causes during this phase of the disease. Methods: From Danish nationwide registries, we identified patients who died in the period 2001–2016 after having experienced HF for at least 1 year, and examined hospitalizations during the last year of life in age- and sex-stratified analyses. Results: We included 32,157 patients. Median age at time of death was 81 years; 39% were women. A total of 26,561 (84%) patients were hospitalized at least once during the last year of life. The patients experienced a median of 2 (1 to 3) hospitalizations and spent 14 (3 to 31) days in the hospital. Of all hospitalizations (n = 80,362), 9,644 (12%) were due to HF, 14,738 (18%) due to other cardiovascular (CV) causes, and 51,696 (64%) due to non-CV causes (p < 0.001). The frequency of hospitalizations increased toward death, but the domination of non-CV causes remained consistent throughout the year, regardless of age and sex. If we included diagnoses covering renal insufficiency in the definition of HF hospitalizations, non-CV hospitalizations remained dominant (58%). Conclusions: During the last year alive, patients with HF were more often hospitalized due to non-CV causes rather than HF. These findings warrant more focus on a multidisciplinary approach toward end-of-life care in patients with HF.

AB - Objectives: This study aimed to evaluate the incidence and causes of hospitalization in the year preceding death of patients with heart failure (HF). Background: Hospitalizations in HF are common, especially in the last period of the lives of patients with HF, but little is known about hospitalization burden and causes during this phase of the disease. Methods: From Danish nationwide registries, we identified patients who died in the period 2001–2016 after having experienced HF for at least 1 year, and examined hospitalizations during the last year of life in age- and sex-stratified analyses. Results: We included 32,157 patients. Median age at time of death was 81 years; 39% were women. A total of 26,561 (84%) patients were hospitalized at least once during the last year of life. The patients experienced a median of 2 (1 to 3) hospitalizations and spent 14 (3 to 31) days in the hospital. Of all hospitalizations (n = 80,362), 9,644 (12%) were due to HF, 14,738 (18%) due to other cardiovascular (CV) causes, and 51,696 (64%) due to non-CV causes (p < 0.001). The frequency of hospitalizations increased toward death, but the domination of non-CV causes remained consistent throughout the year, regardless of age and sex. If we included diagnoses covering renal insufficiency in the definition of HF hospitalizations, non-CV hospitalizations remained dominant (58%). Conclusions: During the last year alive, patients with HF were more often hospitalized due to non-CV causes rather than HF. These findings warrant more focus on a multidisciplinary approach toward end-of-life care in patients with HF.

KW - comorbidity

KW - elderly

KW - heart failure

KW - hospital hospitalization

KW - readmission

UR - http://www.scopus.com/inward/record.url?scp=85067335003&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2019.03.018

DO - 10.1016/j.jchf.2019.03.018

M3 - Journal article

C2 - 31248567

AN - SCOPUS:85067335003

VL - 7

SP - 561

EP - 570

JO - J A C C: Heart Failure

JF - J A C C: Heart Failure

SN - 2213-1779

IS - 7

ER -