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Now more patients with cardiovascular disease are dying at home than in the hospital



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Despite their wishes, many patients die in hospitals or other institutions. Cardiovascular disease (CVD) is a leading cause of death both globally and in the US, but little is known about where CVD patients die. In a new study, physician Haider Warraich, from Brigham and Women's Hospital, and colleagues evaluated the death toll of patients with CVD from 2003 to 2017, finding that the home surpassed the hospital as the most common death site for these patients. The results of their analysis are published in Journal of the American College of Cardiology.

"When I talk to my patients about what's most important to them when they start the rest of their lives, so many of them tell me they want to spend their last moments surrounded by a home," said Warraich, who joined the Cardiovascular Medicine Institute at Brigham in September as Associate Physician. "Understanding where patients die can help us determine how we can provide them with care and what services they will need in these settings."

To conduct their study, investigators examined more than 12 million deaths in the records of public deaths from multiple causes of death from the National Center for Health Statistics. They examined whether the death occurred in a hospital, home, nursing or long-term care facility, inpatient hospital facility, or other (including outpatient, emergency room, and deaths upon arrival at the hospital). They also analyzed demographic characteristics, including race, ethnicity, gender, marital status, educational attainment, and rural-urban status.

The team found that 330,905 CVD deaths occurred at the hospital in 2003, reducing to 234,703 in 2017. Home deaths increased from 192,986 in 2003 to 265,133 in 2017, accounting for about 31 percent of deaths from CVD that year. The team also found that undervalued racial and ethnic groups were more likely to die in hospital and less likely to die at home.

Warraich notes that while the data do provide insight, they do not disclose what the patient's last day or week was and whether they received hospice care at home, nor do the records capture patients' wishes and whether their place of death reflected those wishes.

"Cardiology is lagging behind other specialties in focusing on end-of-life care, but we are now seeing more interest in this important area," Warraich said. "We see more people dying at home than at any other location, but we need to better understand what that experience is so that we can channel the energy to our patients' needs."


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More information:
Sarah H. Cross et al., Trends in Instead of the Death of Individuals with Cardiovascular Disease in the United States, Journal of the American College of Cardiology (2019). Doi: 10.1016 / j.jacc.2019.08.1015

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Brigham and Women’s Hospital

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More cardiovascular patients now die at home than in hospital (2019, October 10)
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