Discharge to hospice among Medicare patients with heart failure was associated with a median survival of 11 days and a 30-day readmission rate of 4.1%, compared to 27.2% in advanced HF patients.
Cohort (n=121,990)
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What are the trends in hospice discharge, readmission rates, and survival among older Medicare patients hospitalized with heart failure?
Hospice use among Medicare heart failure patients has grown to 4.9% of discharges, but nearly a quarter die within 3 days of discharge, suggesting that hospice referral often occurs very late in the disease course.
Tasa de eventos absoluta: 4.1% vs 27.2%
Importance: While 1 in 10 older patients hospitalized with heart failure (HF) die within 30 days, end-of-life care for this population is not well described. Objective: To assess rates of discharge to hospice, readmission after hospice, and survival in hospice in patients following hospital discharge. Design, Setting, and Participants: In this observational cohort analysis of patients in the multicenter American Heart Association Get With The Guidelines (GWTG)-HF registry linked to Medicare fee-for-service claims data, we analyzed patients 65 years and older discharged alive from the hospital between 2005 and 2014. We compared 4588 patients discharged to hospice with 4357 patients with advanced HF (ejection fraction ≤25% and any of the following: inpatient inotrope use, serum sodium level ≤130 mEq/L, blood urea nitrogen level ≥45 mg/dL to convert to micromoles per liter, multiply by 0.357, systolic blood pressure ≤90 mm Hg, or comfort measures during hospitalization) not discharged to hospice and with 113 045 other patients with HF in the GWTG-HF registry. Data were analyzed from October 2017 to June 2018. Main Outcomes and Measures: Discharge to hospice, rehospitalization, and mortality. Results: Of the 4588 patients discharged to hospice, 2556 (55.7%) were female and 4047 (88.2%) were white, and they had a median (interquartile range) age of 86 (80-90) years. Hospice accounted for 4588 of 121 990 discharges (3.8%), of which 2424 (52.8%) were discharges to home hospice and 2164 (47.2%) were to a hospice facility. Hospice discharges increased from 2.0% (109 of 5528) in 2005 to 4.9% (968 of 19 590) in 2014. Patients discharged to hospice were older, white, and more symptomatic compared with patients with advanced HF (n = 4357) and other patients in the GWTG-HF registry (n = 113 045). The median (interquartile range) postdischarge survival time in patients discharged to hospice was 11 (3-63) days compared with 318 (78-1105) days in patients with advanced HF and 754 (221-1868) days in other patients in the GWTG-HF registry. A total of 739 patients (34.1%) discharged to hospice facilities died in less than 72 hours, while 295 (12.2%) discharged to home hospice died in less than 72 hours; 690 patients (15.0%) discharged from hospice lived for 6 months or more. Among hospitals with more than 25 hospice discharges, the median (interquartile range) hospice discharge rate was 3.5% (2.0%-5.7%). Readmission at 30 days was lower in patients discharged to hospice (189 4.1%) compared with patients with advanced HF (1185 27.2%) and others in the GWTG-HF registry (25 022 22.2%). Nonwhite race and younger age were the strongest predictors of readmission from hospice. Conclusions and Relevance: Hospice use has grown to about 4.9% of Medicare HF hospital discharges, with significant hospital-level variation. Almost a quarter of patients discharged to hospice die within 3 days of discharge, and about 4.1% of patients are readmitted to the hospital within 30 days.
Warraich et al. (Thu,) conducted a cohort in Heart failure (n=121,990). Discharge to hospice vs. Advanced heart failure not discharged to hospice and other heart failure patients was evaluated on 30-day readmission. Discharge to hospice among Medicare patients with heart failure was associated with a median survival of 11 days and a 30-day readmission rate of 4.1%, compared to 27.2% in advanced HF patients.