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. 2020 Dec;8(12):1038-1049.
doi: 10.1016/j.jchf.2020.06.009. Epub 2020 Aug 12.

Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

Madeline R Sterling  1 , Lisa M Kern  2 , Monika M Safford  2 , Christine D Jones  3 , Penny H Feldman  4 , Gregg C Fonarow  5 , Shubin Sheng  6 , Roland A Matsouaka  7 , Adam D DeVore  7 , Barbara Lytle  7 , Haolin Xu  7 , Larry A Allen  3 , Anita Deswal  8 , Clyde W Yancy  9 , Nancy M Albert  10
Affiliations

Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

Madeline R Sterling et al. JACC Heart Fail. 2020 Dec.

Abstract

Objectives: This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates.

Background: After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied.

Methods: This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes.

Results: From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC.

Conclusions: Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.

Keywords: heart failure; home health care; mortality; readmission.

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Conflict of interest statement

Author DISCLOSURES This study was funded by an American Heart Association-Get with The Guidelines (GWTG-HF) Young Investigator Database Seed Grant Award (to Dr. Sterling). The GWTG-HF program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. Sterling is supported by K23HL150160 from the National Institutes of Health/National Heart Lung and Blood Institute (NHLBI). Dr. DeVore has received research funding from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, Medtronic, the NHLBI, Novartis and PCORI; and has consulted for AstraZeneca, Bayer, LivaNova, Mardil Medical, Novartis and Procyrion. Dr. Fonarow has consulted for Abbott, Amgen, Bayer, CHF Solutions, Janssen, Medtronic, and Novartis. Dr. Allen has received research funding from the American Heart Association, the National Institutes of Health, and the Patient Centered Outcomes Research Institute; and has received consulting fees from ACI Clinical, Amgen/Cytokinetics, Boston Scientific, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
Participants that comprised the pre- and post- matched cohorts.
Figure 2.
Figure 2.. Love plot of Absolute Standardized Differences Comparing Baseline Characteristics Pre-and Post-Matching
Love plot displaying absolute standardized differences for baseline characteristics of participants and hospitals between those receiving HHC and those not, before and after propensity score matching
Figure 3.
Figure 3.. Home Health Care Utilization Among Adults Hospitalized for Heart Failure in Get With The Guidelines-Heart Failure Registry from 2005 to 2015
The Cochran-Armitage test assessed for trends over time in the receipt of HHC among the overall cohort before matching. Over 10 years, HHC use increased from 31.4% (2005) to 36.1% (2015), p<0.001.
Figure 4.
Figure 4.. (Central Illustration) Cumulative Incidence Plots for 30-Day Readmission and Mortality by Home Health Care Status
Cumulative incidences for post-discharge outcomes at 30 days (a. all-cause readmission; b. HF readmission; c. all-cause mortality; d. all-cause mortality/readmission).
See this image and copyright information in PMC

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