Mapping the Journey: Exploring End-of-Life Settings for Cardiovascular Patients in Italy

Cardiovascular diseases (CVDs) are the leading cause of mortality in Italy. This study aims to describe the setting of death of patients dying from cardiovascular diseases in Italy and to explore potential changes during the COVID-19 pandemic (years 2020 and 2021) in comparison to the previous five years and the first post-pandemic year, 2022. Data from the Italian National Cause of Death Registry were analyzed to identify deaths due to cardiovascular diseases between 2015 and 2022. To evaluate potential changes associated with the COVID-19 pandemic, deaths occurring during the pandemic years (2020–2021) were compared with those recorded in the pre-pandemic period (2015–2019). The year 2022 was included as a post-pandemic descriptive reference year. A total of 221,653 deaths due to CVD occurred in 2022, compared with 217,523 in 2021, 227,350 in 2020, and a mean of 227,468 deaths per year during the five-year period of 2015–2019. Home was the primary setting of death, accounting for 44.3% of CVD deaths in 2022, compared with 46.1% in 2021, 45.8% in 2020, and 42.3% during 2015–2019. This was followed by hospitals, where 35.8% of CVD deaths occurred in 2022, slightly higher than the 35.4% in 2021 and 34.5% in 2020, but still below the 39.3% observed during 2015–2019. Long-term care facilities accounted for 12.9% of deaths in 2022, an increase from 11.5% in 2021, and broadly consistent with the 13.2% reported in 2020 and 11.2% in the previous five-year period. CVD deaths occurring in hospice facilities continued to rise modestly, from 1.2% during 2015–2019, to 1.4% in 2020, 1.8% in 2021, and 1.9% in 2022. Home is the main setting of death for patients with cardiovascular diseases, underscoring the need to implement support and palliative care and improve targeted interventions for home-based CVD patients to enhance quality of life and care at the end of life.