Abstract 20782: Discharge Hospice Referral is Associated With Lower 30-Day All-Cause Readmission in Hospitalized Patients With Heart Failure: A Propensity-Matched Study of the Medicare-Linked OPTIMIZE-HF
Background: Heart failure (HF) is the leading cause for 30-day all-cause readmission - a target for Medicare cost reduction in the Affordable Care Act. Findings from a single state suggest that a discharge hospice referral was associated with lower 30-day all-cause readmission among Medicare beneficiaries hospitalized for HF during 1998-2001 (PMID: 26019151). We examined this association in a more contemporary national cohort of hospitalized patients with HF.
Methods: In the Medicare-linked OPTIMIZE-HF registry, of the 25345 hospitalized patients with HF 479 (2%) received a discharge hospice referral. Of the 24866 patients who did not receive a hospice referral, 5053 (20%) died and were considered hospice eligible (6-month life expectancy is a Medicare hospice eligibility criterion). Propensity scores for hospice referral were estimated for each of the 5532 (479+5053) patients and were used to match 360 hospice-referral patients with 360 hospice-eligible patients who were balanced on 78 baseline characteristics. The 720 matched patients had a mean (±SD) age of 80 (±10) years, a mean (±SD) EF of 40% (±18%), 52% were women, and 09% African American.
Results: 30-day all-cause readmission occurred in 42% and 6% of matched hospice-referral and hospice-eligible patients, resp. (HR, 0.17; 95% CI, 0.12-0.25; Figure). While 30-day mortality was higher in the hospice referral group (61% vs 27%), the higher mortality was unlikely to have explained this lower readmission rate. At 6 month, mortality was lower in the hospice referral group (81% vs 100% in the hospice-eligible group, by definition) and yet hospice referral was associated with lower 6-month all-cause readmission (HR, 0.16; 95% CI, 0.11-0.22). Patients in the hospice referral group had lower 30-day and 6-month HF readmissions.
Conclusion: Among hospitalized patients with HF, a discharge hospice referral was associated with lower 30-day all-cause readmission, which persisted during longer term follow-up.
Author Disclosures: H. Sheriff: None. P.H. Lam: None. C. Arundel: None. D.J. Dooley: None. G. Panjrath: None. R.D. Fletcher: None. M. Blackman: None. J. Butler: None. P. Deedwania: None. M. White: None. I. Kanonidis: None. C. Morgan: None. W. Wu: None. W.S. Aronow: None. R.M. Allman: None. G.C. Fonarow: None. A. Ahmed: None.
- © 2016 by American Heart Association, Inc.