Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure: findings from GWTG-HF.

Authors

• David J Whellan
• Margueritte Cox
• Adrian F Hernandez
• Paul A Heidenreich
• Lesley H Curtis
• Eric D Peterson
• Gregg C Fonarow

Publication/Presentation Date

6-1-2012

Abstract

BACKGROUND: Guidelines recommend hospice care as a treatment option for end-stage heart failure (HF) patients. Little is known regarding utilization of hospice care in a contemporary cohort of patients hospitalized with HF and how this may vary by estimated mortality risk.

METHODS: We analyzed HF patients ≥65 years (n = 58,330) from 214 hospitals participating in the Get With the Guidelines-HF program. Univariate analysis comparing patients discharged to hospice versus other patients was performed. Hospice utilization was evaluated for deciles of estimated 90-day mortality risk using a validated model. Multivariate analysis using admission patient and hospital characteristics was also performed to determine factors associated with hospice discharge.

RESULTS: There were 1,442 patients discharged to hospice, and rates of referral varied widely by hospital (interquartile range 0-3.7%) as shown in the univariate analysis. Patients discharged to hospice were significantly older and more often white, had lower left ventricular ejection fraction, higher B-type natriuretic peptide, and lower systolic blood pressure on admission. Utilization rates for each decile of 90-day estimated mortality risk ranged from 0.3% to 8.6%. Multivariable analysis found that factors associated with hospice utilization included increased age, low systolic blood pressure on admission, and increased blood urea nitrogen.

CONCLUSIONS: Hospice utilization remains low among HF patients, even those with the highest predicted risk of death.

Volume

18

Issue

6

First Page

471

Last Page

477

ISSN

1532-8414

Published In/Presented At

Whellan, D. J., Cox, M., Hernandez, A. F., Heidenreich, P. A., Curtis, L. H., Peterson, E. D., & Fonarow, G. C. (2012). Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure: findings from GWTG-HF. Journal of cardiac failure, 18(6), 471–477. https://doi.org/10.1016/j.cardfail.2012.02.006

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

22633304

Department(s)

Administration and Leadership

Document Type

Article