Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
J Pain Symptom Manage. 2013 Mar;45(3):552-60. doi: 10.1016/j.jpainsymman.2012.03.006. Epub 2012 Aug 30.
Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure.
We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer.
Using Medicare data linked with pharmacy and cancer registry data, we identified patients who were diagnosed with either heart failure or advanced cancer between 1997 and 2004, admitted to hospice at least once after their diagnosis, and died during the study period. We compared patterns of referral, use of acute services, and site of death of hospice patients with heart failure with those of patients with advanced cancer. Logistic regression models were constructed to determine the factors associated with late hospice enrollment as well as the use of and death in acute care.
We identified 1580 heart failure patients and 3840 advanced cancer patients: mean ages were 86 and 80 years, 82% and 68% were women, and 97% and 94% were white, respectively. Compared with patients with advanced cancer, those with heart failure were more frequently referred to hospice from hospitals (35% vs. 24%) and nursing facilities (9% vs. 7%) (both P<0.01). Discharge from hospice before death was similar for patients with heart failure and patients with advanced cancer (10% vs. 9%, P=0.03). Among patients remaining in hospice, patients with heart failure were more likely to have been enrolled within three days of death (20% vs.11%, P<0.01). The prevalence of death in acute care settings was low in both groups after hospice enrollment (4% heart failure vs. 2% advanced cancer, P<0.01). Although the median interval between enrollment and death was shorter for heart failure patients (12 vs. 20 days, P<0.001), emergency department visits and hospitalizations after hospice enrollment were more frequent in patients with heart failure (13% vs. 10% and 9% vs. 6%, respectively, both P<0.01).
Compared with patients with advanced cancer, referral to hospice is more often initiated during acute care encounters for patients with end-stage heart failure, who also more frequently return to acute care settings even after hospice enrollment.
临终关怀传统上用于治疗晚期癌症患者，但现在也越来越多地用于治疗终末期心力衰竭患者。
我们比较了终末期心力衰竭患者和晚期癌症患者的临终关怀入院模式和临床事件。
利用医疗保险数据与药房和癌症登记数据相链接，我们确定了 1997 年至 2004 年间被诊断患有心力衰竭或晚期癌症的患者，这些患者在确诊后至少接受过一次临终关怀，并在研究期间死亡。我们比较了心力衰竭患者和晚期癌症患者的转介模式、急性服务的使用情况和死亡地点。构建逻辑回归模型以确定与晚期临终关怀入院以及急性护理使用和死亡相关的因素。
我们确定了 1580 例心力衰竭患者和 3840 例晚期癌症患者：平均年龄分别为 86 岁和 80 岁，82%和 68%为女性，97%和 94%为白人。与晚期癌症患者相比，心力衰竭患者更常从医院（35%比 24%）和护理机构（9%比 7%）转介到临终关怀机构（均 P<0.01）。心力衰竭患者和晚期癌症患者在临终关怀机构死亡前出院的比例相似（10%比 9%，P=0.03）。在仍留在临终关怀机构的患者中，心力衰竭患者更有可能在死亡前三天内入院（20%比 11%，P<0.01）。两组患者在临终关怀后入住急性护理机构的比例都很低（心力衰竭患者为 4%，晚期癌症患者为 2%，均 P<0.01）。尽管心力衰竭患者的入院到死亡的中位时间间隔较短（12 天比 20 天，P<0.001），但心力衰竭患者在临终关怀后更频繁地到急诊室就诊和住院（13%比 10%和 9%比 6%，均 P<0.01）。
与晚期癌症患者相比，终末期心力衰竭患者更常在急性护理就诊期间被转介到临终关怀机构，即使在临终关怀后，他们也更频繁地返回急性护理机构。
