{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:37:06Z","timestamp":1791247026231,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,1,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with chronic disease prefer an adequately supported death at home, but often die in the hospital. We assessed temporal trends and sex differences in healthcare intensity and location of death among decedents with heart failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This was a retrospective cohort study of adults with heart failure who died between April 1, 2004 and March 31, 2017 in Ontario, Canada. We used population\u2010based administrative databases to assess healthcare utilization during the last 6\u00a0months of life and applied multilevel multivariable logistic regression to assess whether sex was independently associated with location of death. Among 396\u00a0024 decedents with heart failure, mean (SD) age was 81.8 (10.7) years, 51.5% were women, and 53.4% had in\u2010hospital deaths. From 2004 to 2016, there was an increase in patients receiving mechanical ventilation (15.1%\u201319.6%), hemodialysis (5.2%\u20136.8%), and cardiac revascularization (1.7%\u20132.3%). Relative to men, women spent fewer days in a hospital (mean, 16.4 versus 18.3; mean difference, 1.9; 95% CI, 1.7\u20132.0;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and in an intensive care unit (mean, 2.1 versus 3.0; mean difference, 0.9; 95% CI, 0.8\u20130.9;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001); and less commonly received mechanical ventilation (15.5% versus 20.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001); hemodialysis (4.8% versus 7.7%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001); or cardiac catheterization (2.8% versus 4.6%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Female sex was independently associated with lower odds of in\u2010hospital death (odds ratio, 0.88; 95% CI, 0.87\u20130.89). Mean (SD) 6\u2010month direct healthcare cost was greater for in\u2010hospital ($52\u00a0349 [$55\u00a0649]) than out\u2010of\u2010hospital ($35\u00a0998 [$31\u00a0900]) death.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Among decedents with heart failure, invasive care in the last 6\u00a0months increased in prevalence over time but was less common in women, who had lower odds of dying in a hospital.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018495","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T10:21:14Z","timestamp":1608114074000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Temporal Trends and Sex Differences in Intensity of Healthcare at the End of Life in Adults With Heart Failure"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8370-4569","authenticated-orcid":false,"given":"Harriette G. C.","family":"Van Spall","sequence":"first","affiliation":[{"name":"Department of Medicine Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada"},{"name":"Population Health Research Institute Hamilton Ontario Canada"},{"name":"ICES, McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longdi","family":"Fu","sequence":"additional","affiliation":[{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J.","family":"Ross","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre University Health Network Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Fowler","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2017.02.001"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000350"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20150130"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1388-9842(01)00198-2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.08.019"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.125435"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.365"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1202-8"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2016.22.12.1446"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001826"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f4085"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz835"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.33.3.06"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.21368"},{"key":"e_1_3_2_16_2","first-page":"435","article-title":"Chronic conditions and risk of in\u2010hospital death","volume":"29","author":"Iezzoni LI","year":"1994","unstructured":"Iezzoni LI, Heeren T, Foley SM, Daley J, Hughes J, Coffman GA. Chronic conditions and risk of in\u2010hospital death. Health Serv Res. 1994;29:435\u2013460.","journal-title":"Health Serv Res"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216316653524"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_2_19_2","unstructured":"Wodchis WP Bushmeneva K Nikitovic M McKillo I. Guidelines on person\u2010level costing using administrative databases in Ontario. Working Paper Series. Toronto: Health System Performance Research Network. 2013;1:2\u201369."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.150064"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S31552"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-016-0156-x"},{"key":"e_1_3_2_23_2","first-page":"496","article-title":"Place of death: trends over the course of adecade: a population\u2010based study of death certificates from the years 2001 and 2011","volume":"112","author":"Dasch B","year":"2015","unstructured":"Dasch B, Blum K, Gude P, Bausewein C. Place of death: trends over the course of adecade: a population\u2010based study of death certificates from the years 2001 and 2011. Dtsch Arztebl Int. 2015;112:496\u2013504.","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29417"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308638"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.05.030"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20180097"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.018495","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:59:41Z","timestamp":1715597981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.018495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1,5]]}},"alternative-id":["10.1161\/JAHA.120.018495"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.018495","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,5]]},"assertion":[{"value":"2020-07-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e018495"}}