In the Journals

CVD deaths at home increased from 2003 to 2017

Haider J. Warraich

The most common place of death for patients with CVD was home, according to a study published in the Journal of the American College of Cardiology.

“We know from a lot of studies that when you ask people for their preference, most likely they’re going to say that they would like to die at home, so potentially this may mean that we are doing a better job of listening to our patients’ values and goals and are doing a better job of meeting them,” Haider J. Warraich, MD, HF cardiologist at Brigham and Women’s and associate director of heart failure at Boston Veterans Affairs Hospital, told Healio.

Deaths from 2003 to 2017

Sarah H. Cross, MSW, MPH, student at Duke University Sanford School of Public Policy, and colleagues analyzed data from 12,365,572 patients (42% aged 65 to 84 years; 49% men) who died between 2003 and 2017. CVD was the underlying cause of death, which was defined as the injury or disease that initiated events that led to death.

Places of death that were considered were home, hospital, long-term care or nursing facility, inpatient hospital facility and other, which included ED, outpatient medical facility and dead-on-arrival at the hospital.

Of the deaths in this study, 48.2% were attributed to ischemic heart disease, 16.7% were caused by cerebrovascular disease or stroke and 10.6% were attributed to HF or cardiomyopathy.

The number of CVD deaths occurring in the hospital decreased from 36.5% in 2003 to 27.3% in 2017. This decrease was also seen in nursing facilities (25.1% to 20.6%). Increases were observed with regard to home deaths (21.3% to 30.9%) during this period.

“There are many patients who are home, and just being able to be at home even for a short amount of time is of value,” Warraich said in an interview. “What these data don’t tell us is how many people have been in the hospital recently and had just been discharged. Having said that, a patient’s goal might be just that: they want to be able to get treatment in the hospital but then it appears that the end is inevitable, so they would rather spend that at home even if it is for a very short amount of time.”

The difference in hospital deaths between Hispanic and non-Hispanic patients decreased from 10.2% to 7.8% as the difference between black and white patients increased from 4.9% to 5.3%.

Age, CVD diagnosis, sex, marital status, race/ethnicity and education level were significantly linked with place of death.

Compared with white patients, black patients had increased odds of hospital death (OR = 1.29; 95% CI, 1.27-1.3). Black patients also had reduced odds for nursing facility death (OR = 0.75; 95% CI, 0.73-0.77) and home death (OR = 0.84; 95% CI, 0.81-0.87). Hispanic patients had greater odds of hospital death (OR = 1.49; 95% CI, 1.47-1.5) and reduced odds of death in a hospice facility (OR = 0.84; 95%A CI, 0.83-0.86), nursing facility (OR = 0.58; 95% CI, 0.57-0.59) or at home (OR = 0.94; 95% CI, 0.93-0.96).

Deaths by CVD diagnoses

Compared with patients with ischemic heart disease, greater odds of hospital death were seen in patients with stroke (OR = 2.14; 95% CI, 2.07-2.2) and aortic stenosis (OR = 2.47; 95% CI, 2.39-2.56). Patients with stroke had greater odds of death at a nursing facility (OR = 1.25; 95% CI, 1.24-1.25) and hospice facility (OR = 3.3; 95% CI, 3.22-3.29) compared with those with ischemic heart disease. Patients with stroke also had lower odds for dying at home (OR = 0.43; 95% CI, 0.42-0.45).

The greatest odds of home death were seen in patients dying of hypertensive heart disease (OR = 1.37; 95% CI, 1.35-1.39). These patients also had the lowest odds of hospital death (OR = 0.57; 95% CI, 0.56-0.58).

“What cardiologists can do a better job of is thinking about what is the social support that might be present at home, what are the services that a patient or their caregivers might have available to them,” Warraich told Healio. “One of the things that happens when people die at home is that their care is now being increasingly taken care of by their caregivers, so we can do a better job with involving the caregivers and thinking about what are the challenges that they’re facing.” – by Darlene Dobkowski

For more information:

Haider J. Warraich, MD, can be reached at Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132; email: haider.warraich@gmail.com; Twitter: @haiderwarraich.

Disclosures: Cross and Warraich report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Haider J. Warraich

The most common place of death for patients with CVD was home, according to a study published in the Journal of the American College of Cardiology.

“We know from a lot of studies that when you ask people for their preference, most likely they’re going to say that they would like to die at home, so potentially this may mean that we are doing a better job of listening to our patients’ values and goals and are doing a better job of meeting them,” Haider J. Warraich, MD, HF cardiologist at Brigham and Women’s and associate director of heart failure at Boston Veterans Affairs Hospital, told Healio.

Deaths from 2003 to 2017

Sarah H. Cross, MSW, MPH, student at Duke University Sanford School of Public Policy, and colleagues analyzed data from 12,365,572 patients (42% aged 65 to 84 years; 49% men) who died between 2003 and 2017. CVD was the underlying cause of death, which was defined as the injury or disease that initiated events that led to death.

Places of death that were considered were home, hospital, long-term care or nursing facility, inpatient hospital facility and other, which included ED, outpatient medical facility and dead-on-arrival at the hospital.

Of the deaths in this study, 48.2% were attributed to ischemic heart disease, 16.7% were caused by cerebrovascular disease or stroke and 10.6% were attributed to HF or cardiomyopathy.

The number of CVD deaths occurring in the hospital decreased from 36.5% in 2003 to 27.3% in 2017. This decrease was also seen in nursing facilities (25.1% to 20.6%). Increases were observed with regard to home deaths (21.3% to 30.9%) during this period.

“There are many patients who are home, and just being able to be at home even for a short amount of time is of value,” Warraich said in an interview. “What these data don’t tell us is how many people have been in the hospital recently and had just been discharged. Having said that, a patient’s goal might be just that: they want to be able to get treatment in the hospital but then it appears that the end is inevitable, so they would rather spend that at home even if it is for a very short amount of time.”

The difference in hospital deaths between Hispanic and non-Hispanic patients decreased from 10.2% to 7.8% as the difference between black and white patients increased from 4.9% to 5.3%.

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Age, CVD diagnosis, sex, marital status, race/ethnicity and education level were significantly linked with place of death.

Compared with white patients, black patients had increased odds of hospital death (OR = 1.29; 95% CI, 1.27-1.3). Black patients also had reduced odds for nursing facility death (OR = 0.75; 95% CI, 0.73-0.77) and home death (OR = 0.84; 95% CI, 0.81-0.87). Hispanic patients had greater odds of hospital death (OR = 1.49; 95% CI, 1.47-1.5) and reduced odds of death in a hospice facility (OR = 0.84; 95%A CI, 0.83-0.86), nursing facility (OR = 0.58; 95% CI, 0.57-0.59) or at home (OR = 0.94; 95% CI, 0.93-0.96).

Deaths by CVD diagnoses

Compared with patients with ischemic heart disease, greater odds of hospital death were seen in patients with stroke (OR = 2.14; 95% CI, 2.07-2.2) and aortic stenosis (OR = 2.47; 95% CI, 2.39-2.56). Patients with stroke had greater odds of death at a nursing facility (OR = 1.25; 95% CI, 1.24-1.25) and hospice facility (OR = 3.3; 95% CI, 3.22-3.29) compared with those with ischemic heart disease. Patients with stroke also had lower odds for dying at home (OR = 0.43; 95% CI, 0.42-0.45).

The greatest odds of home death were seen in patients dying of hypertensive heart disease (OR = 1.37; 95% CI, 1.35-1.39). These patients also had the lowest odds of hospital death (OR = 0.57; 95% CI, 0.56-0.58).

“What cardiologists can do a better job of is thinking about what is the social support that might be present at home, what are the services that a patient or their caregivers might have available to them,” Warraich told Healio. “One of the things that happens when people die at home is that their care is now being increasingly taken care of by their caregivers, so we can do a better job with involving the caregivers and thinking about what are the challenges that they’re facing.” – by Darlene Dobkowski

For more information:

Haider J. Warraich, MD, can be reached at Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132; email: haider.warraich@gmail.com; Twitter: @haiderwarraich.

Disclosures: Cross and Warraich report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.