Division of Geriatrics and Palliative Medicine, (T.S., L.G., T.C., J.S., J.L.R., M.W.) Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Center of Innovation in Long Term Services and Supports, (L.J., W.C.W., J.L.R., M.W.)Providence VA Healthcare System, Providence, Rhode Island, USA.
J Pain Symptom Manage. 2024 Nov;68(5):525-532. doi: 10.1016/j.jpainsymman.2024.08.026. Epub 2024 Aug 22.
Concurrent care allows patients to receive hospice while continuing disease-directed therapies. This treatment model is available in the Veterans Administration (VA) medical system, but its use in Veterans with heart failure (HF) is unexplored.
To compare use of advanced HF therapies 30 days posthospitalization in Veterans on hospice versus not on hospice following admission for HF exacerbation.
We evaluated Veterans admitted for HF exacerbation to VA hospitals between Jan 2011 and June 2019 who received advanced HF therapies, hospice services, or both postdischarge. Concurrent care was defined as receiving both hospice services and advanced HF therapies. Demographics, comorbidities, and prior healthcare utilization were compared. Secondary outcomes included burdensome transitions and mortality.
Among 317,967 HF Veterans, 18,350 (5.8%) chose hospice posthospitalization. Only 58 hospice-enrolled Veterans (0.3%) received advanced HF therapies (i.e. concurrent care) within 30 days postdischarge. Of 299,617 Veterans not on hospice, 6,083 (2.0%) received advanced HF therapies (0.3% vs. 2.0%; P < 0.001). Veterans receiving concurrent care had higher six-month mortality than those receiving advanced HF therapies alone (77.6% vs. 14.9%, SMD 1.61). Hazard of burdensome transitions was similar (adjusted HR 1.44, 95% CI 0.95-2.17).
Veterans with HF receiving concurrent care were few and experienced higher mortality. Rate of burdensome transitions was similar between Veterans receiving concurrent care and those not on hospice. Further research may explore why Veterans infrequently utilize concurrent care at the end of life.
同时护理允许患者在接受临终关怀的同时继续接受针对疾病的治疗。这种治疗模式在退伍军人事务部（VA）医疗系统中可用，但尚未在心力衰竭（HF）退伍军人中进行探索。
比较在因 HF 恶化而住院的退伍军人中，接受临终关怀与不接受临终关怀的退伍军人在出院后 30 天内使用先进 HF 治疗的情况。
我们评估了 2011 年 1 月至 2019 年 6 月期间在 VA 医院因 HF 恶化而入院的退伍军人，他们在出院后接受了先进的 HF 治疗、临终关怀服务或两者兼有。同时护理被定义为同时接受临终关怀服务和先进的 HF 治疗。比较了人口统计学、合并症和先前的医疗保健利用情况。次要结果包括负担过重的过渡和死亡率。
在 317967 名 HF 退伍军人中，有 18350 人（5.8%）选择了出院后的临终关怀。只有 58 名登记为临终关怀的退伍军人（0.3%）在出院后 30 天内接受了先进的 HF 治疗（即同时护理）。在 299617 名未接受临终关怀的退伍军人中，有 6083 人（2.0%）接受了先进的 HF 治疗（0.3%比 2.0%；P<0.001）。接受同时护理的退伍军人的六个月死亡率高于单独接受先进 HF 治疗的退伍军人（77.6%比 14.9%，SMD 1.61）。负担过重的过渡的风险相似（调整后的 HR 1.44，95%CI 0.95-2.17）。
接受同时护理的 HF 退伍军人人数较少，死亡率较高。接受同时护理和未接受临终关怀的退伍军人之间的负担过重的过渡率相似。进一步的研究可能会探讨为什么退伍军人在生命的最后阶段很少使用同时护理。
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