More patients may choose U. heart disease to die at home

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(Reuters Health) – There are fewer U patients with cardiovascular disease dying in hospitals and more are dying at home.

Between 2003 and 2017, among more than 12 million Americans died of cardiovascular disease, the percentage who died at home rose from 23% to 31%, researchers reported in the Journal of the American College of Cardiology.

“It is very important for a large number of people to die at home,” said coauthor. Haider Warraich, associate director of heart failure program at Boston VA Healthcare System, and instructor in Harvard Medical School. “Historically, everyone died at home. The arrival of modern medicine changed. ”

Researching how to improve people's days and hours, researchers focused on hospital care because most people died there, said Warraich. “Increasingly, researchers are trying to develop resources for patients who are dying at home so that the experience can be as good as possible,” he said.

Warraich allows death at home is not the best choice for everyone. “It depends on their needs,” he said. “I think it's important for us to study this too.” T

To look more closely at how people die in the United States, Warraich and data colleagues from the National Center for Health Statistics and Disease Control and Prevention Centers are merged.

Focusing on natural deaths with cardiovascular disease as a primary cause, the researchers broke down the list in categories such as heart attack, stroke and heart failure.

Ultimately, they found that cardiovascular disease mainly resulted in 12.3 million deaths between 2003 and 2017. Almost half, 48.2%, were attributed to coronary heart disease, and 16.6% caused heart failure or cardiomyopathy 16.7%.

In 2003, 36.5% of deaths occurred in a hospital, compared to 27.3% in 2017. Home deaths increased from 21.1% in 2003 to 30.9% in 2017.

However, the pattern varied across the country. In 2017, patients were less likely to die in hospital in the Mountain census region – 23% died in the hospital – than in the South-Central region, with the highest number of hospital deaths at 32.1%. New England had the lowest percentage of deaths in the country in the country with just 27.2% in 2017.

Race and ethnicity appeared to have a role where people died. “Racist and ethnic minorities were more likely to die in hospital than white people,” said Warraich. “Some details suggest that this may be related to whether there are resources at home to support someone who wants to die at home.” T

The new study provides "good news," said Dr. Albert Wu, an intern and professor of health policy and management at Johns Hopkins Public Health School. “Studies dating back to the 1990s document that people would be seriously missing at home. The increase in the number of people dying at home suggests that more people are taking their choices forward – and this is progress. ”

However, “it is worrying that there is an imbalance with fewer people on low income and black dying at home,” said Wu in an email. While the authors suggest that this may be related to a lack of services, “it seems to me that this may indicate that there is less power or less voice to honor your final choices.

Through education and home support programs, “families are more comfortable about providing end of life care in the home,” said Dr. Gerald Beckham, cardiologist at PIH Health Physicians.

“Newer programs like home health, palliative care, and hospice can provide resources and help in ways that emotional, financial and physical stress can care for a loving person outside the hospital,” Beckham said in an email.

SOURCE: bit.ly/2OtWLBK Journal of the American College of Cardiology, online October 7, 2019.

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. t) Cardio (t) Internal Medicine (t) Clinical Medicine (t) Heart Failure / ACS (t) Healthcare (TRBC) (t) United States of America

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