Author + information
- Received February 20, 2019
- Accepted March 14, 2019
- Published online June 24, 2019.
- Christian Madelaire, MDa,∗ (, )
- Finn Gustafsson, MD, PhD, DMScb,
- Søren L. Kristensen, MD, PhDb,
- Maria D’Souza, MDa,
- Lynne W. Stevenson, MDc,
- Lars Kober, MD, DMScb,
- Christian Torp-Pedersen, MD, DMScd,
- Gunnar Gislason, MD, PhDa,e and
- Morten Schou, MD, PhDa
- aDepartment of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- bThe Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- cDivision of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- dDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- eDanish Heart Foundation, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Christian Madelaire, Copenhagen University Hospital Herlev og Gentofte, Department of Cardiology, Cardiovascular Research Unit 1, Post 635, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
Objectives This study aimed to evaluate the incidence and causes of hospitalization in the year preceding death of patients with heart failure (HF).
Background Hospitalizations in HF are common, especially in the last period of the lives of patients with HF, but little is known about hospitalization burden and causes during this phase of the disease.
Methods From Danish nationwide registries, we identified patients who died in the period 2001–2016 after having experienced HF for at least 1 year, and examined hospitalizations during the last year of life in age- and sex-stratified analyses.
Results We included 32,157 patients. Median age at time of death was 81 years; 39% were women. A total of 26,561 (84%) patients were hospitalized at least once during the last year of life. The patients experienced a median of 2 (1 to 3) hospitalizations and spent 14 (3 to 31) days in the hospital. Of all hospitalizations (n = 80,362), 9,644 (12%) were due to HF, 14,738 (18%) due to other cardiovascular (CV) causes, and 51,696 (64%) due to non-CV causes (p < 0.001). The frequency of hospitalizations increased toward death, but the domination of non-CV causes remained consistent throughout the year, regardless of age and sex. If we included diagnoses covering renal insufficiency in the definition of HF hospitalizations, non-CV hospitalizations remained dominant (58%).
Conclusions During the last year alive, patients with HF were more often hospitalized due to non-CV causes rather than HF. These findings warrant more focus on a multidisciplinary approach toward end-of-life care in patients with HF.
The study was sponsored by the Danish Heart Foundation, Copenhagen, Denmark (17-R116-A7610-22048). Dr. Gustafsson has been a speaker for Orion, Abbott, Novartis, and Boehringer-Ingelheim; an unpaid advisor for Corvia and Carmat; and an advisor for Pfizer and Pharmacosmos. Dr. Torp-Pedersen has received a grant for a clinical trial by Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 20, 2019.
- Accepted March 14, 2019.
- 2019 American College of Cardiology Foundation
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