Abstract 149: Care for Heart Failure Patients at the End of Life: Hospital Readmission and Mortality Amongst Heart Failure Patients Discharged to Hospice

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Haider J Warraich ◽  
Adam Devore ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Paul Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Median Survival ◽  
Hospital Readmission ◽  
Discharge Rate ◽  
Care Plan ◽  
High Risk Population ◽  
White Race ◽  
Heart Failure Patients ◽  
Hospice Patients

Background: While 1 in 10 patients hospitalized with heart failure (HF) die within 30 days, end-of-life care for this high-risk population is not well described. Methods: We analyzed patients discharged alive from the Get With The Guidelines-HF registry between 2005-2014, linked to Medicare claims. We compared patients discharged to hospice to non-hospice “advanced HF” patients (ejection fraction ≤25% and either on inotropes, sodium ≤130, blood urea nitrogen ≥45 mg/dL, systolic blood pressure ≤90 mmHg or comfort measures) and to other GWTG-HF patients. Results: Of 121,990 US patients, hospice patients (n=4588, 2164 facility-based, 2424 home hospice) compared with advanced HF (n=4357) and others (113,045) were older (median age 86 years vs 78 years vs 81 years), more likely white race (88% vs 80% vs 82%), have intravenous loop diuretics used (74% vs 57% vs 63%), have an advanced care plan/surrogate decision maker discussed or documented (76% vs 62% vs 66%), had more dyspnea at rest (55% vs 46% vs 48%) and worse/unchanged symptoms at discharge (35% vs 2% vs 1%) (all p<0.01). Discharge to hospice increased from 2% (n=109) in 2005 to 5% (n=968) in 2014. Median survival in hospice was 11 days (25 th , 75 th percentile: 3, 65 days) compared with advanced HF (318 days) and others (754 days); 34% of patients discharged to a hospice facility and 12% to home hospice died in <3 days. (Figure) Median survival in hospice did not change significantly from 2005 to 2014. Hospital readmission at 30 days was 4% among hospice, 27% for advanced HF, and 22% for others. Median hospice discharge rate was 3.0 (0.7, 5.5). Hospice discharges had lower adjusted hazards of all-cause readmission (hospice compared with others: advanced HF odd ratio (OR) 0.15 (95% confidence interval (CI) 0.13-0.18), others OR 0.15 (95% CI 0.13-0.18). Hospice patients also had lower 6-month and 1-year readmission rate. Non-white race (OR 1.59 [95% CI 1.18-2.17]) and younger age (OR per 5 years 1.18 [95% CI 1.10-1.27)] were the strongest predictors of readmission from hospice. Conclusion: Hospice use in patients hospitalized with HF is limited but increasing. Few hospice patients are rehospitalized and almost a quarter die within 3 days of discharge. These findings may inform interventions to improve hospice care for HF patients.

Abstract 150: Care for Heart Failure Patients at the End of Life: Hospital Readmission and Mortality Amongst Heart Failure Patients Discharged to Hospice

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Haider J Warraich ◽  
Adam DeVore ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Paul Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Median Survival ◽  
Hospital Readmission ◽  
Discharge Rate ◽  
Care Plan ◽  
High Risk Population ◽  
White Race ◽  
Heart Failure Patients ◽  
Hospice Patients

Background: While 1 in 10 patients hospitalized with heart failure (HF) die within 30 days, end-of-life care for this high-risk population is not well described. Methods: We analyzed patients discharged alive from the Get With The Guidelines-HF registry between 2005-2014, linked to Medicare claims. We compared patients discharged to hospice to non-hospice “advanced HF” patients (ejection fraction ≤25% and either on inotropes, sodium ≤130, blood urea nitrogen ≥45 mg/dL, systolic blood pressure ≤90 mmHg or comfort measures) and to other GWTG-HF patients. Results: Of 121,990 US patients, hospice patients (n=4588, 2164 facility-based, 2424 home hospice) compared with advanced HF (n=4357) and others (113,045) were older (median age 86 years vs 78 years vs 81 years), more likely white race (88% vs 80% vs 82%), have intravenous loop diuretics used (74% vs 57% vs 63%), have an advanced care plan/surrogate decision maker discussed or documented (76% vs 62% vs 66%), had more dyspnea at rest (55% vs 46% vs 48%) and worse/unchanged symptoms at discharge (35% vs 2% vs 1%) (all p<0.01). Discharge to hospice increased from 2% (n=109) in 2005 to 5% (n=968) in 2014. Median survival in hospice was 11 days (25 th , 75 th percentile: 3, 65 days) compared with advanced HF (318 days) and others (754 days); 34% of patients discharged to a hospice facility and 12% to home hospice died in <3 days. (Figure) Median survival in hospice did not change significantly from 2005 to 2014. Hospital readmission at 30 days was 4% among hospice, 27% for advanced HF, and 22% for others. Median per-hospital hospice discharge rate over the study perior was 3% (1%, 6%). Hospice discharges had lower adjusted hazards of all-cause readmission (hospice compared with others: advanced HF odd ratio (OR) 0.15 (95% confidence interval (CI) 0.13-0.18), others OR 0.15 (95% CI 0.13-0.18). Hospice patients also had lower 6-month and 1-year readmission rate. Non-white race (OR 1.59 [95% CI 1.18-2.17]) and younger age (OR per 5 years 1.18 [95% CI 1.10-1.27)] were the strongest predictors of readmission from hospice. Conclusion: Hospice use in patients hospitalized with HF is limited but increasing. Few hospice patients are rehospitalized and almost a quarter die within 3 days of discharge. These findings may inform interventions to improve hospice care for HF patients.

47 Knowsley Trigger Tool - A Tool to Aid Identification of Heart Failure Patients Nearing End of Life and Promote Communication Between Heart Failure Specialist Nurses and Primary Care

Heart ◽  
2014 ◽  
Vol 100 (Suppl 3) ◽  
pp. A26-A27 ◽  
Author(s):  
Karen Dickman ◽  
Marjorie Carey ◽  
Archana Rao ◽  
Amanda Worthington ◽  
Linda Hilton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
End Of Life ◽  
Trigger Tool ◽  
Heart Failure Patients ◽  
Specialist Nurses

Abstract 270: Emergency Service Use in Heart Failure Patients on Hospice

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Meredith A MacKenzie
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Emergency Service ◽  
Service Use ◽  
Hospice Care ◽  
Care Needs ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Hospice Patients

Introduction: Emergency service use should be almost non-existent among hospice patients, as hospice is intended to provide for all care needs at the end of life. Cancer patients comprise almost 50% of hospice patients nation-wide and have relatively low rates of emergency service use while on hospice care. Hospice enrollment has been steadily increasing among patients with heart failure, but concerns have been raised about how well hospice care meets these patients’ needs. Emergency service use is one indicator of how well heart failure patients’ needs are met on hospice. Objective: To explore whether emergency service use is higher among heart failure patients on hospice as compared to cancer patients on hospice and reasons for this potential disparity. Methods: This is a secondary analysis of the 2007 National Home and Hospice Care Survey (NHHCS). Only hospice patients with heart failure (n=311) and hospice patients with breast, prostate, colon or lung cancer (n=946) were included in the analysis. Emergency service use was measured by response to NHHCS question 73 (“did the patient use one or more types of emergent care?”) and includes the use of both emergency room and outpatient (urgicenter) services. Multiple logistic regression was used to examine the relationship between emergency service use and diagnosis. All analyses were adjusted for hospice length of stay, patient age, race/ethnicity, caregiver relationship, number of comorbidities, functional status, cognitive function and place of care. Results: Subjects (M age 75.3, SD 12.68) were 51% female and 89% white. The rate of emergency service use was 9.6% among the cancer patients and 17.36% among heart failure patients. Heart failure patients were almost two times more likely to utilize emergency services (OR 1.96, p<.002). Among the covariates examined, only hospice length of stay was significantly associated with emergency service use (p<.000), but did not appear to make a clinically significant difference (OR 1.003). Conclusions: While this study lends support to the hypothesis that heart failure patients suffer unmet care needs while on hospice, the nature of these unmet needs should be further explored. Outcome disparities have previously been suggested to be due to differences in age, comorbidities and functional status between the heart failure and cancer populations, but this study does not support that hypothesis. Hospice care plans unique to the heart failure patient should be considered.

scholarly journals Assess frailty but avoid frailtyism

2019 ◽  
Vol 21 (Supplement_L) ◽  
pp. L17-L19
Author(s):  
Cristiana Vitale ◽  
Loreena Hill
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Clinical Practice ◽  
Care Plan ◽  
Heart Failure Patients ◽  
Frailty Assessment ◽  
Limited Health ◽  
Selection Of Patients ◽  
Selection Of ◽  
Made In

Abstract The assessment of frailty in heart failure patients can help clinicians to build a tailored care plan, aimed at improving the selection of patients likely to benefit from one treatment vs. another, thereby improving outcomes. Although progress has been made in the ‘operationalization’ of frailty assessment, there is still the need to provide an improved instrument to assess frailty that is easy, quick and at the same time predictive within the setting of a busy clinical practice. Using such an ideal instrument, clinicians would be able to optimize the use of limited health care resources and avoid what has been termed ‘frailtyism’. This term, similar to ageism, can be defined as prejudice or discrimination based on the presence of frailty.

scholarly journals CARE MANAGEMENT CHALLENGES AND PROGNOSTIC TOOLS FOR HEART FAILURE PATIENTS IN HOSPICE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S791-S791
Author(s):  
Ruth Masterson Creber ◽  
Lizeyka Jordan ◽  
Dawon Baik ◽  
David Russell
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Medical Devices ◽  
Care Management ◽  
Qualitative Interviews ◽  
Heart Failure Patients ◽  
Performance Scale ◽  
Worse Prognosis ◽  
Management Issues ◽  
At Home

Abstract Heart failure (HF) patients enroll in hospice at lower rates despite their worse prognosis. This multi-method study explores the characteristics and challenges associated with caring for HF patients. Data from qualitative interviews with hospice providers (n=32) and quantitative records (N=1,114) were used to identify care management issues and prognostic tools. Hospice providers described HF patients unique and often unpredictable symptomatology, their limited understanding and discordant hospice expectations, and difficulties managing symptoms at home. Providers also highlighted HF patients use of assistive medical devices and complex medication regimens. Palliative Performance Scale (PPSv2) scores at hospice enrollment were found to be strongly associated with hospice survival (AUC: 7 days=0.80; 14 days=0.77) and live discharge risk (PPSv2 50-70% AOR=5.68 [CI=3.66-8.79]). Findings underscore the need for specially-tailored trainings and protocols for providers to prevent unplanned discharges and support HF patients at end-of-life.

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