A Look at Trends in Hospice Discharge and Outcomes in GWTG-HF Registry Patients

Hospice use is rare in patients with heart failure (HF) and those patients are often referred late, a new analysis published in JAMA Cardiology suggests.  

Researchers for this observational cohort analysis included 4,588 patients in the American Heart Association Get With The Guidelines (GWTG)-HF registry who were discharged to hospice care (55.7% female) compared to 4,357 patients with advanced HF who were not discharged to hospice, and also to 113,045 patients with HF in the GWTG-HF registry. They then linked them to Medicare fee-for-service claims data between 2005 and 2014. The primary study outcomes of interest were discharge to hospice, rehospitalization and mortality. 

Comprehensive study of #endoflife care and #hpm shows only 5% of hospitalized #Medicare patients with #heartfailure are discharged to #hospice of whom 1/4 die within 48 hours and 1/3 are discharged with worsening symptoms. Much room for improvement https://t.co/lIvDVZvHWp

— JAMA Cardiology (@JAMACardio) August 29, 2018

The results suggested that hospice discharges increased from 2.0% in 2005 to 4.9% in 2014. Those discharged to hospice tended to be older, white, and more symptomatic than patients with advanced HF.  Median postdischarge survival time in those discharged to hospice was 11 days, compared to 318 days in patients with advanced HF and 754 in the GWTG-HF registry. Median post-discharge survival rate was 3.5%, and readmission at 30 days was lower in discharged-to-hospice patients compared to the other groups. Additionally, nonwhite race and younger age were predictors of readmission from hospice. 

“Hospice use has grown to about 4.9% of Medicare HF hospital discharges, with significant hospital-level variation,” the researchers wrote. “Almost a quarter of patients discharged to hospice die within 3 days of discharge, and about 4.1% of patients are readmitted to the hospital within 30 days.” 

This really resonates with me as a #hospitalist since we are bearing more of the onus of caring for hospitalized patients with #heartfailure. We can certainly do more to ensure these patients get timely #palliativecare, since many have multiple hospital encounters at #endoflife. https://t.co/3zygo3C5jN

— Nauzley Abedini (@NauzleyAbedini) August 30, 2018

Check out this excellent & extremely important study on #endoflife care in #heartfailure in @JAMACardio by @haiderwarraich & colleagues. Underused, & when used, it’s often too late. Disservice to patients. https://t.co/QZLD2Qwl91

— Rohan Khera (@rohan_khera) August 29, 2018

https://twitter.com/ajaykirtane/statuses/1034923749462573057

All you need to know about #heartfailure and #hospice #hpm is in this paper today in @JAMACardio w/ @gcfmd @texhern @NMHheartdoc @_adevore @DLBHATTMD & others. 1/4th die within 3 days. Many discharged w/ worsening symptoms. Many readmitted. Details follow: https://t.co/AmEJTo1kCN

— Haider Warraich (@haiderwarraich) August 29, 2018

Outstanding work by @haiderwarraich and the GWTG-HF highlighting important opportunity to improve care. Trends in Hospice Discharge and Outcomes Among Medicare Patients in the GWTG-HF Registry https://t.co/U8TAuVNtYU @texhern @NMHheartdoc @DLBHATTMD @DCRINews @JAMACardio

— Gregg Fonarow MD (@gcfmd) August 29, 2018

Source: JAMA Cardiology