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Deaths from heart failure and cancer: location trends
  1. Izza Shahid1,
  2. Pankaj Kumar2,
  3. Muhammad Shahzeb Khan3,
  4. Abdul Wahab Arif3,
  5. Muhammad Zain Farooq3,
  6. Safi U Khan4,
  7. Dorothy M Davis5,
  8. Erin D Michos5 and
  9. Richard A Krasuski6
  1. 1Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
  2. 2Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
  3. 3Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  4. 4Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
  5. 5Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  6. 6Department of Cardiovascular Medicine, Duke University Health System, Durham, North Carolina, USA
  1. Correspondence to Dr Muhammad Shahzeb Khan, Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60601, USA; shahzebkhan{at}


Background Increasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight.

Methods Complete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations.

Results Among 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice.

Conclusion Deaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.

  • hospice care
  • nursing home care
  • quality of life

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  • Contributors IS, PK, MSK and RAK contributed to the conception and design of the study. PK, AWA and MZF contributed to the acquisition and analysis of data, which was reviewed by MSK. IS, AWA, MZF, SUK and RAK interpreted the results. IS, PK and MSK drafted the manuscript. SUK, DMD, EDM and RAK critically revised the manuscript. All authors reviewed and approved the final version of the manuscript. All authors are responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database (, which includes death certificate data from 2001 to 2017, for all deaths occurring in the United States. Individual level data from 1 January 2013 to 31 December 2017 were obtained from the Mortality Multiple Cause-of-Death Public Use Record for 2013-2017 from the National Center for Health Statistics (NCHS) ( Since this is publicly available data, no conditions of reuse (e.g licence, embargo) apply.