Heart failure and the cost of dying: must the ferryman always be paid?

Abstract

AbstractBackgroundProvision of palliative care in chronic heart failure (CHF) can support complex decision‐making, significantly improve quality of life and may lower healthcare costs.AimsTo examine whether healthcare costs differed in terminal admissions according to the adoption of a palliative approach.DesignRetrospective review of medical records and costing data for all admissions resulting in death from CHF (July 2011 to December 2019), analysed as two groups (2011–2016 and 2016–2019) because of background changes in costings.SettingAdmissions with CHF resulting in death in an Australian tertiary referral centre.ResultsThe cohort (n = 439) were elderly (median age 83.7 years, interquartile range (IQR) = 77.6–88.7 years) and mostly men (54.9%). Half (230, 52.4%) were referred to a specialist palliative care team, whereas over a third (172, 39.2%) received a palliative approach. Receiving a palliative approach was associated with a nonstatistically significant lower admission cost (AU$12 710 vs AU$15 978; P = 0.19) between 2011 and 2016 (n = 101, 38.8%) and a significantly lower cost (AU$11 319 vs AU$15 978; P < 0.01) between 2016 and 2019 (n = 71, 39.7%). Intensive care admission resulted in the single greatest additional cost at AU$14 624 (IQR = AU$4130–AU$44 197) (n = 48, 2011–2016). Median terminal admission cost was lower for patients with comfort goals of care (P < 0.01), without life‐sustaining interventions (P < 0.01) or who received a palliative approach (P < 0.01).Referral to inpatient specialist palliative care or receiving a palliative approach resulted in comparable admission costings (AU$11 621 [IQR = AU$4705–AU$32 457] and AU$11 466 [IQR = AU$4973–AU$25 614]).ConclusionA palliative approach in terminal CHF admission may improve quality at the end of life and decrease costs associated with care.