Article Figures & Tables
Figures
- Figure 1:
Study flow diagram. Note: CHPC = collaborative home-based palliative care, LHIN = Local Health Integration Network, LVAD = left ventricular assist device, OHIP = Ontario Health Insurance Plan.
- Figure 2:
Association between collaborative home-based palliative care, location of death (in hospital v. out of hospital) and health care use (hospital admission, emergency department [ED] use, use of intensive care unit [ICU]) among matched patients who died with heart failure between 2013 and 2019 in the Toronto Central and Central Local Health Integration Networks in Ontario, Canada. Estimates for location of death were adjusted for the presence of renal disease, the number of cardiologist visits, hospital admissions in the year before the index date, cardiovascular devices and procedures, whether the person received home care with an end-of-life designation, hospital frailty risk score category, prescriptions for medications used in the care of people with heart failure (including anticoagulants, β-blockers, mineralocorticoid receptor antagonists, digoxin, furosemide and opioids) and the total number of unique medication prescriptions in the year before the index date. Secondary outcomes of health care use were modelled without adjustment. Note: CI = confidence interval.
- Figure 3:
Kaplan–Meier estimates for time to first hospital admission among patients who received collaborative home-based palliative care (CHPC; blue) and matched patients who received usual care (red), who died with heart failure between 2013 and 2019 in the Toronto Central and Central Local Health Integration Networks in Toronto, Ontario.
Tables
- Table 1:
Baseline characteristics of patients who died with heart failure, including those who received collaborative home-based palliative care and those who received usual care
Characteristic No. (%) of patients* Standardized difference Usual care
n = 1172Collaborative home-based palliative care
n = 245Age, yr, mean ± SD 88.1 ± 7.9 88.2 ± 7.9 0.00 Sex, female 647 (55.2) 133 (54.3) 0.02 Living arrangement Alone 177 (15.1) 38 (15.5) 0.01 With family 295 (25.2) 67 (27.3) 0.07 Other 700 (59.7) 140 (57.1) 0.07 Local Health Integration Network Toronto Central 628 (53.6) 136 (55.5) 0.04 Central 109 (44.3) 109 (44.3) 0.01 Neighbourhood income quintile 1–2 728 (62.1) 154 (62.9) 0.00 3–5 443 (37.8) 91 (37.1) 0.00 Recent immigrant 102 (8.7) 19 (7.8) 0.02 Hospital frailty risk score, mean ± SD 4.8 ± 4.8 4.5 ± 4.1 0.06 Duration of heart failure, yr, median (IQR) 4.5 (1.5–8.8) 4.7 (1.7–9.1) 0.00 Chronic conditions Atrial fibrillation or flutter 761 (64.9) 168 (68.6) 0.06 Cancer 803 (68.5) 164 (66.9) 0.03 Chronic kidney disease 554 (47.3) 136 (55.5) 0.17 Chronic obstructive pulmonary disease 340 (29.0) 71 (29.0) 0.00 Coronary artery disease 815 (69.5) 176 (71.8) 0.03 Dementia 263 (22.4) 61 (24.9) 0.05 Diabetes 466 (39.8) 101 (41.2) 0.03 Hypertension 1120 (95.6) 234 (95.5) 0.01 Stroke 179 (15.3) 43 (17.6) 0.05 Cardiovascular devices† Pacemaker 91 (7.8) 23 (9.4) 0.06 Implantable cardioverter defibrillator 32 (2.7) 11 (4.5) 0.09 Percutaneous coronary intervention 78 (6.7) 20 (8.2) 0.07 Previous health care use‡, median (IQR) Cardiologist visits 4 (1–9) 16 (6–32) 0.77 Emergency department use§ 1 (0–2) 1 (0–2) 0.12 Hospital admissions 1 (0–2) 2 (1–3) 0.70 Designated end-of-life home care service goal¶ 8 (0.7) 56 (22.9) 0.73 Note: IQR = interquartile range, SD = standard deviation.
↵* Unless indicated otherwise.
↵† Inserted or performed within 5 years (pacemaker) or 10 years (implantable cardioverter defibrillator) before index date.
↵‡ Health care use in the 12 months before index date.
↵§ Emergency department visits not resulting in hospital admission.
↵¶ Home care clients with an end-of-life service goal receive additional services from a nurse trained in palliative care.
- Table 2:
Medication use at baseline of patients aged 65 years and older who died with heart failure, including those who received collaborative home-based palliative care and those who received usual care
Medication No. (%) of patients Standardized difference Usual care
n = 1153Collaborative home-based palliative care
n = 243ACE inhibitor or ARB 640 (55.5) 134 (55.1) 0.01 Antiarrhythmic 92 (8.0) 33 (13.6) 0.18 Antithrombotic Antiplatelet 202 (17.5) 45 (18.5) 0.02 Anticoagulant 573 (49.7) 149 (61.3) 0.23 β-blocker 704 (61.1) 178 (73.3) 0.27 Cholesterol lowering Ezetimibe 50 (4.3) 8 (3.3) 0.05 Statin 675 (58.5) 150 (61.7) 0.06 Digoxin 149 (12.9) 52 (21.4) 0.23 Diuretic (loop) Furosemide 857 (74.3) 234 (96.3) 0.64 Metolazone 88 (7.6) 74 (30.5) 0.61 MRA 167 (14.5) 90 (37.0) 0.53 Opioid 541 (46.9) 154 (63.4) 0.33 Other antihypertensive Calcium channel blocker 409 (35.5) 78 (32.1) 0.06 Thiazide 119 (10.3) 26 (10.7) 0.02 Note: ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blockers, MRA = mineralocorticoid receptor antagonist.
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