• Kieran L Quinn, Therese A Stukel, Erin Campos, Cassandra Graham, Dio Kavalieratos, Susanna Mak, Leah Steinberg, Peter Tanuseputro, Meltem Tuna, and Sarina R Isenberg.
• Department of Medicine (Quinn, Campos, Graham, Mak), University of Toronto, Toronto, Ont.; ICES (Quinn, Stukel, Tanuseputro, Tuna), Toronto, Ont. and Ottawa, Ont.; Department of Medicine (Quinn, Mak, Steinberg), Sinai Health System; Interdepartmental Division of Palliative Care (Quinn, Steinberg), Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ont.; Division of Palliative Medicine, Department of Family and Preventive Medicine (Kavalieratos), Emory University, Atlanta, Ga.; Clinical Epidemiology Program (Tanuseputro, Tuna), Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine (Tanuseputro) and Department of Medicine (Tanuseputro, Isenberg), University of Ottawa; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Department of Family and Community Medicine (Quinn, Steinberg, Isenberg), University of Toronto; Division of Cardiology (Mak), Sinai Health System; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.
• CMAJ. 2022 Sep 26; 194 (37): E1274E1282E1274-E1282.

BackgroundInnovative models of collaborative palliative care are urgently needed to meet gaps in end-of-life care among people with heart failure. We sought to determine whether regionally organized, collaborative, home-based palliative care that involves cardiologists, primary care providers and palliative care specialists, and that uses shared decision-making to promote goal- and need-concordant care for patients with heart failure, was associated with a greater likelihood of patients dying at home than in hospital.MethodsWe conducted a population-based matched cohort study of adults who died with chronic heart failure across 2 large health regions in Ontario, Canada, between 2013 and 2019. The primary outcome was location of death. Secondary outcomes included rates of health care use, including unplanned visits to the emergency department, hospital admissions, hospital lengths of stay, admissions to the intensive care unit, number of visits with primary care physicians or cardiologists, number of home visits by palliative care physicians or nurse practitioners, and number of days spent at home.ResultsPatients who received regionally organized, collaborative, home-based palliative care (n = 245) had a 48% lower associated risk of dying in hospital (relative risk 52%, 95% confidence interval 44%-66%) compared with the matched cohort (n = 1172) who received usual care, with 101 (41.2%) and 917 (78.2%) patients, respectively, dying in hospital (number needed to treat = 3). Additional associated benefits of the collaborative approach included higher rates of clinician home visits, longer time to first hospital admission, shorter hospital stays and more days spent at home.InterpretationAdoption of a model of regionally organized, collaborative, home-based palliative care that uses shared decision-making may improve end-of-life outcomes for people with chronic heart failure.© 2022 CMA Impact Inc. or its licensors.

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