Abstract 12215: Objective Stratification of Six-Month Mortality Risk among Patients Referred to Hospice
Introduction: The Intermountain Mortality Risk Scores (IMRS) are a suite of sex-specific mortality risk stratification tools created from the complete blood count (CBC), basic metabolic profile (BMP), and age. Patients referred to hospice should have probable 6-month mortality, but this is currently estimated based on clinical gestalt.
Hypothesis: Use of an objective clinical decision tool like IMRS may improve estimation of 6-month mortality risk for evaluation of patient referral to hospice.
Methods: Subjects were Intermountain Healthcare patients who were referred to hospice (females: n=1,753, males: n=1,522) from 2009-2014. Baseline CBC and BMP laboratory data from the time of initial referral to hospice were used to compute the previously-derived IMRS scores. Cox regression and Kaplan-Meier survival curves were used for statistical analyses to evaluate six-month all-cause mortality risk.
Results: Females averaged 77.2±14.2 years of age, and males were 74.4±14.6 years. Six-month survival was 37% in females and 33% in males; stratified into IMRS deciles, survival was 44.9% in decile 1 and 27.8% in decile 10 for females, while in males survival was 39.5% and 25.2%, respectively. Females had hazard ratio (HR)=1.72 (95% CI=1.34, 2.18; p<0.001) for decile 10 vs. 1, and males had HR=1.57 (95% CI=1.18, 2.09; p=0.002). Stratified by previously-established IMRS thresholds (Figure), 12%, 38%, and 50% of females were grouped into low-, intermediate-, and high-risk groups, respectively, and 10%, 31%, 59% of males were in those groups.
Conclusions: About one third of hospice patients did not die within 6 months, suggesting that additional objective evidence is needed to guide referral. IMRS, an evidence-based clinical decision tool derived in a large healthcare population, significantly stratified mortality risk in hospice patients. An electronically-deliverable stratification tool, IMRS may be useful in evaluation of patient risk prior to hospice referral.
Author Disclosures: B.D. Horne: Other Research Support; Significant; Other research funded by risk score-related grants from Intermountain Healthcare’s Foundry innovation program, the Intermountain Research and Medical Foundation, Scriplogix, Inc., and AstraZeneca. Other; Significant; Inventor of risk scores that are licensed to Scriplogix, Inc. for commercial development. J.B. Muhlestein: Other Research Support; Significant; Other research funded by risk score-related grants from AstraZeneca. H.T. May: Other; Significant; Inventor of risk scores that are licensed to Scriplogix, Inc. for commercial development. B.S. Ronnow: Other; Significant; Inventor of risk scores that are licensed to Scriplogix, Inc. for commercial development. T.L. Bair: None. D.L. Lappé: Other Research Support; Significant; Other research funded by risk score-related grants from AstraZeneca.
- © 2016 by American Heart Association, Inc.