Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure

Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice. Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life. This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020. A total of 48,466 deceased patients diagnosed with heart failure on Medicare. Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services. In the final cohort of 48,466 patients (median [IQR] age, 83 [76–89] years; 24,838 [51.2