As the population ages, health care epidemiologist Padma Kaul and cardiologist Paul Armstrong, researchers in the Faculty of Medicine & Dentistry at the University of Alberta, want health-care professionals to talk to their patients about their options on places to die, whether it be at home, in hospital or a palliative care facility like hospice.
The researchers found, in their recent study, that the majority of heart failure patients pass away in an acute care hospital and the cost is more than double for those who died elsewhere.
This is the first study to examine health-care costs, including inpatient, outpatient, physician, and drug costs, at the end of life among heart failure patients in Canada. Researchers examined data on over 30,000 elderly patients with heart failure who died between 2000 and 2006 in Alberta.
"End of life is a big issue, not only in Canada but in the western world," said Kaul, an Alberta Innovates-Health Solutions Investigator. "If you ask anyone they want to die with dignity surrounded by their loved ones, I don't think anyone wants to die in the hospital with tubes coming out of their various body parts. Nobody has really looked at this issue specifically in the heart failure population."
More than 500,000 Canadians live with heart failure and another 50,000 acquire it each year. The aging Canadian population assures that heart failure rates will increase substantially in coming years and pose a major challenge to the publicly funded Canadian health-care system.
"It is critical for the Canadian health-care system and for all of us to engage in a discussion about where people spend their last days," said Armstrong, senior author on the paper which was published in the online October 11 edition of Archives of Internal Medicine. "We need to ask how they'd like to be treated and how this should be best handled in a health-care system that's straining and re-examining how to best use limited resources."
Kaul is a co-author on a similar study conducted among elderly patients in the United States, which will also appear in the same issue of the scientific journal. The study shows a dramatic increase in the use of hospice facilities among heart failure patients between 2000 and 2007.