SALT LAKE CITY — A national retrospective cohort study suggests that patients with advanced heart failure remain in hospice longer than advanced cancer patients do, and that the Medicare hospice benefit, which is based on a 6-month life expectancy, “is poorly designed for heart failure patients,” according to Kevin T. Bain, Pharm.D.
The study, which was presented at the annual meeting of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association, included a national cohort of more than 12,000 patients with heart failure. For comparison, the investigators included a second cohort of more than 31,000 cancer patients.
All patients were discharged alive or dead from 500 hospices between Jan. 1, 2004, and June 30, 2005, said Dr. Bain, a research associate with excelleRx in Philadelphia. Researchers at Thomas Jefferson University, Philadelphia, cooperated in the study.
Patients with the larger spectrum of end-stage heart disease (ESHD) are underrepresented in the nation's hospices, Dr. Bain explained, noting that in 2005, 46% of those admitted to hospice had advanced cancer, while only 12% of admissions were for ESHD. “We estimate that patients with heart failure make up about 6% of hospice admissions,” Dr. Bain said in an interview.
Among the study's findings:
▸ The median length of stay was 17 days for HF patients and 14 days for cancer patients. Hospice stays exceeding 6 months were 8% and 1%, respectively.
▸ Heart failure patients were older and more likely to be women.
▸ Heart failure patients were more likely to receive hospice care in the long-term care setting, while cancer patients were more likely to receive care in their own homes.
▸ Fully 20% of HF patients were discharged from hospice alive, compared with 11% of cancer patients.
▸ The mean time to death was 91 and 32 days, while the median time to death was 22 and 16 days for HF and cancer patients, respectively.
The Medicare hospice benefit defines “terminally ill” as a person certified by the attending physician and the hospice medical director to have a life expectancy of 6 months or less.
“This requirement may pose a barrier to patients being referred earlier or more timely to hospice,” Dr. Bain commented in an interview.
“These findings underscore the limitations of the Medicare hospice certification. Heart failure has a difficult prognosis, and we find that patients could be enrolled very late in the disease and may have a short hospice length of stay, or they may be enrolled beyond 6 months,” he said.
The Medicare hospice benefit 'is poorly designed for heart failure patients.' DR. BAIN