Heart disease remains the number one killer of both men & women in the US. However, not everyone dies a quick & sudden death from a massive heart attack or dysrhythmic collapse. Instead, due to the modern miracles of medicine, many suffer for an inordinate number of years with damaged hearts leading to heart failure while one in four die within the first year after the diagnosis is first made and one in three die within a year of hospitalization for heart failure. In fact, heart failure accounts (at least partially) for one in eight deaths.
Given the grim statistics above, it's imperative that we start talking to our patients about their goals and their desires for (specific) treatment soon after, if not immediately upon, diagnosis so that even as we work to mitigate the complications of heart failure, we can also palliate the symptoms in a fashion consistent with the patient and family's desire.
Towards that end, two studies were published last month looking at the cost of care during the last six months of life in the US and in Canada over the past decade or so. Given our general love of the care offered by our neighbor to the north to all her citizens, it's surprising to me that there were more similarities than differences. Surely, the way medicine is practiced has changed during this same period of time, something documented in both studies. But importantly, only one in three in the US died in the hospital with hospice use increasing over this period of time, coincident with a surge in the number of hospitals with palliative care programs.
We're not there yet. We're still not optimally caring for our dying, once it's clear that death is imminent in the next 6 months or so. But we're slowly getting better.
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