Where Adults with Heart Failure Die: Insights from the CDC-WONDER Database

BACKGROUND: Although there is increasing emphasis on introducing palliative care for patients with Heart failure, it is not well characterized where adults with HF spend their final days before death. AIM: This study analyzed the locations and circumstances of death among adults with HF in the United States using data from the CDC-WONDER database. METHODS: The study examined mortality data of individuals aged ≥20 years, with HF listed as the underlying cause of death between 1999 and 2023. The place of death was categorized as the emergency room (ER), hospice/nursing home, inpatient medical facility, or home. Multivariable logistic regression was used to determine the relationship between death location and demographic factors. RESULTS: From 1999 to 2023, HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. CONCLUSIONS: We highlight the changing patterns in the locations of death among HF patients, emphasizing the need for improved home and hospice care services. Addressing disparities in healthcare access and enhancing palliative care are essential for improving end-of-life experiences. Further research is needed to investigate the factors that contribute to these trends.