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Home-Time After Discharge Among Patients Hospitalized With HF
Study Questions:
The objective of this study was to characterize home-time following hospitalization for heart failure (HF) and assess its relationship with patient characteristics and traditionally reported clinical outcomes.
Methods:
Data from Get With the Guidelines-Heart Failure was linked to Medicare inpatient patient claims data, skilled nursing facility claims data, and the beneficiary summary file from January 1, 2011, to December 31, 2014. The primary outcome was post discharge home-time. Secondary outcomes included death, the composite of death, or all-cause readmission. Home-time was calculated at 30 days, 1 year, and 2 years post initial hospitalization discharge.
Results:
A total of 59,736 patients was included in the study. Mean age was 80.7 years, median ejection fraction (EF) was 50%, and 84.4 of patients were white. The most common comorbidities included atrial fibrillation, diabetes, anemia, and chronic real insufficiency. Disposition at time of discharge was home (43.7%), with an additional 25.6% discharged home with home care, 21.6% discharged to skilled nursing facility, and 4.1% discharged to hospice. Home-time showed a strong positive correlation time free from death and time free from composite of death or HF readmission. The strongest correlation was seen at 2 years and modest correlation at 30 days. Conditions that were associated with reduced home-time at 1 and 2 years included anemia, chronic renal insufficiency, chronic obstructive pulmonary disease, diabetes, dementia, and malnutrition. There was no significant difference in total post-discharge home-time by the EF group (reduced EF = 240.5 days; borderline EF [40-49%] = 249.5 days; p = 0.12). Morality rate at 1 year (40.6%) and the contribution of death to reduced home-time was greatest among patients with reduced EF. Reduction in home-time at 30 days was due to discharge to skilled nursing facility. Reduction in home-time for 1 and 2 years was due to death. An increase in home-time showed a high degree of correlation with time free from death and composite of death or HF hospitalization at 1- and 2-year follow-up.
Conclusions:
Home-time is a novel method to report HF outcomes. It is easier for patients and families to understand severity of disease. Home-time, or the lack of, can represent the risk of mortality and morbidity associated with HF, including the burden of repeated hospitalizations, hospitalization complexity and length of stay, and time spent in rehabilitation and nursing facilities.
Perspective:
In patients over 65 years, home-time can be considered as another method for predicting long-term outcomes in patients with HF. The use of claims data can be challenging in research but effective when determining utilization of health care resources. There is potential for the use of home-time as determinate of quality outcomes and net benefit of an intervention.
Keywords: Heart Failure, Home Care Services, Hospitalization, Skilled Nursing Facilities, Length of Stay, Patient Readmission, Patient Discharge, Stroke Volume
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