Home-Time After Discharge Among Patients Hospitalized With Heart Failure

Background: Surveys of patients with cardiovascular disease have suggested that “home-time”—being alive and out of any healthcare institution—is a prioritized outcome. This novel measure has not been studied among patients with heart failure (HF). Objectives: This study sought to characterize home-time following hospitalization for HF and to assess its relationship with patient characteristics and traditionally reported clinical outcomes. Methods: Using Get With The Guidelines-Heart Failure registry data, patients with a HF hospitalization and discharged alive between 2011 to 2014 and age ≥65 years were identified. Using Medicare claims, post-discharge home-time over 30-day and 1-year follow-up was calculated for each patient as the number of days alive and spent outside of a hospital, skilled nursing facility (SNF), or rehabilitation facility. Results: Among 59,736 patients, 57,992 (97.1%) and 42,153 (70.6%) had complete follow-up for home-time calculation through 30 days and 1 year, respectively. Mean (standard deviation) home-time was 21.6 (11.7) days at 30 days and 243.9 (137.6) days at 1 year. Contributions to reduced home-time varied by follow-up period, with days spent in SNF being the largest contributor though 30 days and death being the largest contributor through 1 year. Over 1 year, 2,044 (4.8%) patients had no home-time following index hospitalization discharge, while 8,194 (19.4%) had 365 days of home-time. In regression models, several conditions were associated with substantially reduced home-time, including pulmonary disease, renal insufficiency, and dementia. Through 1-year, home-time was highly correlated with time-to-event endpoints of death (r=0.94) and the composite of death or HF readmission (r=0.73). Conclusions: Home-time, which can be readily calculated from administrative claims data, is substantially reduced for many patients following hospitalization for HF and is highly correlated with traditional time-to-event mortality and hospitalization outcomes. Home-time represents a novel, easily measured, patient-centered endpoint that may reflect effectiveness of interventions in future HF studies.