Heart Failure Deaths Shift to Home, Hospice, but Racial Disparities Persist

Between 1999 and 2022, there was an increase in the proportion of heart failure (HF)–related deaths of people 65 years and older in their home or hospice care compared with medical facilities and nursing homes, according to a recent study published in the Journal of the National Medical Association.¹

As HF-related mortality shifts from hospitals to homes and hospice settings, this study suggests these trends might not benefit all populations equally. Prior research has shown that racial and ethnic disparities influence when patients first experience HF hospitalization, often delaying diagnosis and access to specialized care among minority populations.² These new national data reveal persistent differences in where older adults with HF die, highlighting how structural inequities across race, sex, and geography may shape end-of-life care access and outcomes long after initial diagnosis.¹

The study used data from the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER). Death certificates where HF was the underlying or contributing cause of death in US adults aged 65 years or older were used. Between 1999 and 2022, there were 6,767,325 HF-related deaths in patients 65 years and older. Of them, 30.04% occurred in either a patient's home or hospice facility, 37.15% in medical facilities, and 28.50% in nursing homes.

Results were stratified by race and sex, among several other covariates. Overall, 55.35% were female, 0.39% were non-Hispanic (NH) American Indian or Alaskan Native, 1.61% were Asian Pacific or Pacific Islander, 8.16% were NH African American, 85.32% were NH White, and 4.2% were Hispanic.

The proportion of deaths that occurred in a patient's home or hospice facility increased from 17.33% in 1999 to 41.15% in 2022 (average annual percent change [AAPC], 3.93; 95% CI, 3.76-4.14). However, those that occurred in medical facilities decreased from 48.44% in 1999 to 32.21% in 2022 (AAPC, –1.70; 95% CI, –1.79 to –1.61), and in nursing homes decreased from 31.89% to 21.53% (AAPC, –2.07; 95% CI, –2.33 to –1.88).

Women had a lower proportion of deaths in their homes or hospice facilities (27.7% vs 33.0%) and medical facilities (34.4% vs 40.6%) compared with men, but significantly higher proportions in nursing homes (33.3% vs 22.5%). Regarding race, the Hispanic population had the highest proportion of deaths in patient homes or hospice facilities (36.1%) and the lowest proportion in nursing homes (15.1%) across all racial groups. The majority of racial groups followed the larger trend, with a decrease in deaths occurring in medical facilities and nursing homes and an increase occurring in patient homes and hospice facilities.

However, NH African American patients had the lowest proportion of deaths occurring in patient homes or hospice facilities (28.9%) and the highest proportion in medical facilities (48.9%), whereas NH White patients had the highest proportion of HF-related deaths occurring in nursing homes (30.3%) and the lowest proportions in medical facilities (35.4%).

When stratified by region, the West had the highest proportions of HF-related deaths occurring in patient homes and hospice facilities, with an increase of 21.79 percentage points from 1999 to 2022 (AAPC, 3.05; 95% CI, 2.88-3.22). The South region also had a similar increase in deaths that occurred in patient homes and hospice facilities, increasing from 18.13% in 1999 to 44.18% in 2022 (AAPC, 4.05; 95% CI, 3.78-4.30).

“Our findings demonstrate a substantial shift in the place of death amongst older adults with HF in the United States over this time frame,” the study authors wrote. “This aligns with national data showing a steady rise in hospice utilization for various life-limiting conditions, including HF.”

The study was limited by its reliance on the CDC’s WONDER data, which are subject to misclassifications or inaccuracies in cause-of-death reporting. The analysis was observational and descriptive, thus limiting the ability to infer causality or explore underlying reasons for observed disparities. The study also lacked detailed clinical information, socioeconomic status, or patient-level factors that could influence the place of death.

“There has been a significant shift in the place of death amongst older adults with HF in the United States,” the study authors concluded. “However, despite this progress, significant demographic and geographic disparities have persisted in the place of death.”

References:

1. Jabbar ABA, Mansoor T, Abidin Z, et al. National trends and disparities in place of death of heart failure-related mortality among older adults in the United States, 1999 to 2022. J Natl Med Assoc. Published online December 21, 2025. doi:10.1016/j.jnma.2025.12.001

2. McCrear S. Racial, ethnic disparities may impact age differences at first heart failure hospitalization. AJMC^®. September 4, 2025. Accessed December 23, 2025. https://www.ajmc.com/view/racial-ethnic-disparities-may-impact-age-differences-at-first-heart-failure-hospitalization