Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

Raya E Kheirbek¹, Ross D Fletcher¹, Marie A Bakitas¹, Gregg C Fonarow¹, Sridivya Parvataneni¹, Donna Bearden¹, Frank A Bailey¹, Charity J Morgan¹, Steven Singh¹, Marc R Blackman¹, Michael R Zile¹, Kanan Patel¹, Momanna B Ahmed¹, Rodney O Tucker¹, Cynthia J Brown¹, Thomas E Love¹, Wilbert S Aronow¹, Jeffrey M Roseman¹, Michael W Rich¹, Richard M Allman¹, Ali Ahmed²

Affiliations

¹ From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.).
² From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.). aliahmedmdmph@gmail.com.

PMID: 26019151
PMCID: PMC4964848
DOI: 10.1161/CIRCHEARTFAILURE.115.002153

Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

Raya E Kheirbek et al. Circ Heart Fail. 2015 Jul.

. 2015 Jul;8(4):733-40.

doi: 10.1161/CIRCHEARTFAILURE.115.002153. Epub 2015 May 27.

Authors

Affiliations

¹ From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.).
² From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.). aliahmedmdmph@gmail.com.

PMID: 26019151
PMCID: PMC4964848
DOI: 10.1161/CIRCHEARTFAILURE.115.002153

Abstract

Background: Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown.

Methods and results: Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998-2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years; 58% women; 18% non-white). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio associated with hospice referral, 0.12; 95% confidence interval, 0.06-0.24). Hazard ratios (95% confidence intervals) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post discharge were 0.03 (0.04-0.21) and 0.17 (0.08-0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% versus 27%), it was similar at 90 days (64% versus 67% among hospice-eligible patients).

Conclusions: A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized patients with HF. However, most patients with HF who died within 6 months of hospital discharge did not receive a discharge hospice referral.

Keywords: Medicare; heart failure; hospice; readmission.

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Figures

**Figure 1**
Flow chart displaying assembly of matched inception cohort of hospice-referral and hospice-eligible patients

**Figure 2**
Love plot displaying absolute standardized differences comparing 28 baseline characteristics between hospice-referral and hospice-eligible heart failure patients, before and after propensity score matching. ACEI (angiotensin converting enzyme inhibitors); ARB (angiotensin receptor blockers)

**Figure 3**
Kaplan Meier plot for 30-day all-cause readmission among propensity-matched hospice-referral and hospice-eligible heart failure patients. (CI=Confidence Interval)

**Figure 4**
Hazard ratio and 95% confidence interval (CI) for 6-month all-cause readmission among subgroups of propensity matched hospice-referral and hospice-eligible heart failure patients. COPD (chronic obstructive pulmonary disease)

See this image and copyright information in PMC

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Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

Affiliations

Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous