Despite their wishes, many patients die in hospitals or other facilities. Cardiovascular disease (CVD) is the leading cause of death both globally and in the U.S., yet little is known about where patients with CVD die. In a new study, Haider Warraich, MD, of Brigham and Women's Hospital, and colleagues assessed place of death for CVD patients from 2003 to 2017, finding that home has surpassed the hospital as the most common place of death for these patients. The results of their analysis are published in the Journal of the American College of Cardiology.
"When I talk to my patients about what's most important to them as they begin to reach the end of life, so many of them tell me they want to spend their last moments surrounded by the familiarity of home," said Warraich, who joined the Division of Cardiovascular Medicine at the Brigham in September as an associate physician. "Understanding where patients die can help us determine how we can deliver care to them and what services they'll require in those settings."
To conduct their study, investigators examined more than 12 million deaths in the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics. They looked at whether deaths occurred in a hospital, home, nursing or long-term care facility, inpatient hospice facility, or other (including outpatient medical facility, emergency department, and dead-on-arrival at the hospital). They also analyzed demographic characteristics, including race, ethnicity, sex, marital status, education level and rural-urban status.
The team found that 330,905 CVD deaths occurred in the hospital in 2003, decreasing to 234,703 in 2017. Deaths at home increased from 192,986 in 2003 to 265,133 in 2017, accounting for about 31 percent of the CVD deaths that year. The team also found that underserved racial and ethnic groups were more likely to die in the hospital and less likely to die at home.
Warraich notes that while the data provide insights, they do not reveal what the last days or weeks of patients' life were like and whether they received hospice care at home, nor do the data capture patients' wishes and whether their place of death reflected those wishes.
Cardiology has lagged behind other specialties in focusing on end-of-life care, but we're now seeing more interest in this important area. We're seeing that more people are dying at home than at any other location, but we need to better understand what that experience is like so that we can focus our energy on the needs of our patients.
Haider Warraich, MD, of Brigham and Women's Hospital
Cross, S. H. et al. (2019) Trends in Place of Death for Individuals With Cardiovascular Disease in the United States. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2019.08.1015