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August 30, 2018JAMA CardiologyOpen Access

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.

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Why the study?

What are the trends in hospice discharge, readmission rates, and survival among older Medicare patients hospitalized with heart failure?

Population

121,990 Medicare fee-for-service patients aged 65 years and older discharged alive from the hospital with…

Comparison

Discharge to hospice vs Discharge without hospice

Design

Cohort

Key result

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.

Authors

HWHaider J. WarraichHXHaolin XuADAdam D. DeVore

Discussion

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Member takes

Overview

Hospice discharge remains infrequent in HF; extends observational trends but leaves optimal timing and selection open for prospective study.

Study Design

Type

Cohort (n=121,990)

Multicenter

Yes

Structured PICO

What are the trends in hospice discharge, readmission rates, and survival among older Medicare patients hospitalized with heart failure?

P
Population
121,990 Medicare patients aged 65 years and older discharged alive following hospitalization for heart failure between 2005 and 2014.
E
Exposure
Discharge to hospice (home hospice or hospice facility)
C
Comparator
Discharge without hospice (advanced HF patients and other HF patients)
O
Outcome
Rates of discharge to hospice, rehospitalization, and mortalityhard clinical

Main Result

Absolute Event Rate: 4.1% vs 27.2%

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.

Cite This Study

Warraich et al. (2018) 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.

synapsesocial.com/papers/6a41badfabd1df9ea90d2365https://doi.org/10.1001/jamacardio.2018.2678
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