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Readmission of Heart Failure Patients Referred to Hospice on Discharge
Study Questions:
What is the association of hospice referral at discharge with 30-day all-cause readmission for heart failure patients?
Methods:
This study was conducted from The Alabama Heart Failure Project on 8,555 Medicare patients discharged with a diagnosis of heart failure from July 1, 1998 to October 31, 2011. Of the 8,049 patients who were discharged alive, 2% were referred to hospice. The primary outcome was all-cause readmission within 30 days of hospital discharge. Secondary outcomes included all-cause readmission within 3-6 months of hospital discharge, HF readmission, all-cause mortality, and the composite endpoint of all-cause mortality or all-cause readmission at 1, 3, and 6 months after hospital discharge.
Results:
A total of 358 patients had a mean age of 79 years, 58% were female, and 18% were African American. Of these patients, 23% had 30-day all-cause readmissions (in 5% of hospice-referral patients and 41% of hospice-eligible patients; hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.06-0.24). Three-month all-cause readmissions occurred in 13% and 59% of patients in the hospice-referral and hospice-eligible groups (HR, 0.18; 95% CI, 0.12-0.29). Hospice referral was associated with lower 3-month heart failure readmission, but had no association with 3-month all-cause mortality. Six-month all-cause readmission occurred in 18% and 64% of hospice-referral and hospice-eligible patients (HR, 0.18; 95% CI, 0.12-0.28). Six-month all-cause mortality was 73% among hospice-referral patients.
Conclusions:
A discharge hospice referral was associated with lower 30-day all-cause readmission; however, most heart failure patients who died within 6 months of hospital discharge did not receive a hospice referral at time of discharge.
Perspective:
As heart failure readmission reductions have been a target for improved patient care, a co-management approach with multidisciplinary teams must be considered when managing such patients. Hospice and palliative care teams should often be included in the management of heart failure patients in order to provide not only improved patient care, but also to help identify strategies to reduce 30-day all-cause readmissions.
Keywords: Geriatrics, Heart Failure, Hospice Care, Medicare, Palliative Care, Patient Discharge, Patient Readmission
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