Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2024 Jul;54(7):1077-1086. doi: 10.1111/imj.16338. Epub 2024 Feb 13.
Provision of palliative care in chronic heart failure (CHF) can support complex decision-making, significantly improve quality of life and may lower healthcare costs.
To examine whether healthcare costs differed in terminal admissions according to the adoption of a palliative approach.
Retrospective review of medical records and costing data for all admissions resulting in death from CHF (July 2011 to December 2019), analysed as two groups (2011-2016 and 2016-2019) because of background changes in costings.
Admissions with CHF resulting in death in an Australian tertiary referral centre.
The cohort (n = 439) were elderly (median age 83.7 years, interquartile range (IQR) = 77.6-88.7 years) and mostly men (54.9%). Half (230, 52.4%) were referred to a specialist palliative care team, whereas over a third (172, 39.2%) received a palliative approach. Receiving a palliative approach was associated with a nonstatistically significant lower admission cost (AU$12 710 vs AU$15 978; P = 0.19) between 2011 and 2016 (n = 101, 38.8%) and a significantly lower cost (AU$11 319 vs AU$15 978; P < 0.01) between 2016 and 2019 (n = 71, 39.7%). Intensive care admission resulted in the single greatest additional cost at AU$14 624 (IQR = AU$4130-AU$44 197) (n = 48, 2011-2016). Median terminal admission cost was lower for patients with comfort goals of care (P < 0.01), without life-sustaining interventions (P < 0.01) or who received a palliative approach (P < 0.01). Referral to inpatient specialist palliative care or receiving a palliative approach resulted in comparable admission costings (AU$11 621 [IQR = AU$4705-AU$32 457] and AU$11 466 [IQR = AU$4973-AU$25 614]).
A palliative approach in terminal CHF admission may improve quality at the end of life and decrease costs associated with care.
在慢性心力衰竭（CHF）中提供姑息治疗可以支持复杂的决策，显著提高生活质量，并可能降低医疗保健成本。
研究在终末期入院时，姑息治疗方法的采用是否会导致医疗费用的差异。
对 2011 年 7 月至 2019 年 12 月期间所有因 CHF 死亡的入院患者的病历和成本数据进行回顾性分析，根据成本计算的背景变化，将其分为两组（2011-2016 年和 2016-2019 年）。
澳大利亚三级转诊中心因 CHF 导致死亡的入院患者。
该队列（n=439）患者年龄较大（中位数年龄 83.7 岁，四分位间距（IQR）=77.6-88.7 岁），且大多数为男性（54.9%）。有一半（230 例，52.4%）患者被转介至专科姑息治疗团队，而超过三分之一（172 例，39.2%）接受了姑息治疗方法。与 2011 年至 2016 年（n=101，38.8%）相比，接受姑息治疗方法的患者入院费用较低（AU$12710 与 AU$15978；P=0.19），而与 2016 年至 2019 年（n=71，39.7%）相比，费用显著降低（AU$11319 与 AU$15978；P<0.01）。重症监护病房入院是导致费用增加的主要原因，费用为 AU$14624（IQR=AU$4130-AU$44197）（n=48，2011-2016 年）。有舒适治疗目标（P<0.01）、无生命维持干预（P<0.01）或接受姑息治疗（P<0.01）的患者，其终末期入院的中位费用较低。转介至住院专科姑息治疗或接受姑息治疗方法的患者的入院费用相当（AU$11621[IQR=AU$4705-AU$32457]和 AU$11466[IQR=AU$4973-AU$25614]）。
在终末期 CHF 入院时采用姑息治疗方法可能会改善生命末期的生活质量，并降低护理相关成本。
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