Abstract P112: End-of-Life Care in Heart Failure: Differences Between the U.S. and Canada
Bibliographic record
Abstract
Background: Heart failure (HF) is a debilitating and chronic condition with high mortality, yet little is known about costs of care at the end of life and how they differ between the US and Canada. The objective was to compare health care resource use during the last six months of life between the US and Canada among elderly patients with HF. Methods: We used a 5% national sample of Medicare beneficiaries with HF (age 65+) who died from 2000-2006 and patients in the Alberta Cardiac Access Collaborative Heart Failure cohort (age 65+) who died from 2000-2006. We tallied all-cause hospitalizations, intensive care unit (ICU) days, outpatient physician visits, and the use of tests and procedures in the 180 days preceding death. We examined the level of care at the time of death. We assessed trends over time within each country and, among patients who died in 2006, we directly compared end of life care between countries. Results: The cohort included 204,520 Medicare beneficiaries and 33,144 patients in the province of Alberta, Canada. The average age at death was 83 in both countries. The proportion of US patients hospitalized in the last six months of life was constant at 81% over the study period. In Canada, by contrast, the proportion hospitalized decreased from 84% in 2000 to 76% in 2006 (p<.001). Resource use at the end of life differed between the countries ( Table ). The mean number of inpatient days was higher in Canada, but mean ICU days were higher in the US. The use of most tests and procedures was higher in the US. Patients in Canada were more likely to die in the hospital, but US. patients were more likely to be in the ICU during the terminal hospitalization. Conclusion: There are substantial differences in the management of heart failure patients in the US and Canada in the last six months of life. Further research is needed to understand the role of patient and provider preferences in the observed cross-country differences. End of Life Resource Use among HF Patients in the US and Canada, 2006 US (n=26 550) Canada (n = 4857) p-value Resource use in the 180 days preceding death Any hospitalization 21 540 (81) 3703 (76) <.001 Inpatient days, mean (SD) 21 (22) 34 (35) <.001 ICU days, mean (SD) 4.4 (9.3) 1.5 (7.0) <.001 Stress test, no. (%) 1568 (5.9) 70 (1.4) <.001 Cardiac catheterization no. (%) 1536 (5.8) 167 (3.4) <.001 CABG no. (%) 348 (1.3) 39 (0.8) 0.003 Inpatient at time of death, no. (%) 9491 (35.7) 2622 (54.0) <.001 ICU, no. (%) 4563 (48.1) 546 (12.1) <.001
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".