Trends in Place of Cardiovascular Deaths Related to Heart Failure in the United States from 2003-2017

Objectives While most patients would prefer to die at home, the majority of deaths among patients with HF still occur in medical facilities. Increased hospice utilization in the past decade for cardiovascular diseases (CVD) may have contributed to changing national trends in place of death for HF patients. Therefore, we sought to describe the distribution of and trends in location for CVD deaths among patients with HF between 2003 and 2017. Methods HF-related CVD deaths were ascertained using the multiple cause of death files from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data, which includes the underlying and contributing cause of death from all death certificates in the US. HF-related CVD deaths were identified whereby CVD (International Classification of Diseases, 10thRevision, I00-I78) was listed as underlying cause of death and HF (ICD-10 I50) was listed as contributing cause of death, or HF (ICD-10 I50) was listed as underlying cause of death from January 1, 2003 to December 31, 2017. We performed linear regression with place of death as dependent variable and time as independent variable and calculated odds ratios for sex and race. Findings We identified 3,888,803 HF-related CVD deaths between 2003 and 2017 with 44% occurring in men, 9% in blacks, and 92% among individuals > age 65 years. From 2003 to 2017, proportion of deaths in hospice facilities and at home increased more than 40-fold (0.2% to 8.2%; Ptrend Conclusions While the majority of patients who die of HF-related CVD are still dying in medical facilities, increases in the proportion of patients dying in hospice facilities and at home may reflect a greater focus on patient-centered care at the end of life. More research is needed to better understand preferred location of death, hospice utilization during home deaths, and disparities in location and preferred place of death among HF patients.