TY - JOUR
T1 - Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure
T2 - Findings from GWTG-HF
AU - Whellan, David J.
AU - Cox, Margueritte
AU - Hernandez, Adrian F.
AU - Heidenreich, Paul A.
AU - Curtis, Lesley H.
AU - Peterson, Eric D.
AU - Fonarow, Gregg C.
N1 - Funding Information:
The Get With the Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. The GWTG-HF program is currently supported in part by Medtronic . GWTG-HF has been funded in the past through support from GlaxoSmithKline.
Funding Information:
Dr Whellan receives research grants from Medtronic and consults for Medtronic ( 10k) from BMS/Sanofi, Lilly, and Johnson & Johnson. Dr Fonarow receives research support from the National Heart, Lung, and Blood Institute (significant) and Agency for Healthcare Research and Quality (significant) and is a consultant for Novartis (significant) and Medtronic (modest).
PY - 2012/6
Y1 - 2012/6
N2 - 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.
AB - 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.
KW - Hospice referral
KW - palliative care
KW - registries
KW - risk factors
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U2 - 10.1016/j.cardfail.2012.02.006
DO - 10.1016/j.cardfail.2012.02.006
M3 - Article
C2 - 22633304
AN - SCOPUS:84861608385
SN - 1071-9164
VL - 18
SP - 471
EP - 477
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 6
ER -