Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure: findings from GWTG-HF.
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.
Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. david.whellan@jefferson.edu
David J
DJ
Whellan
Margueritte
M
Cox
Adrian F
AF
Hernandez
Paul A
PA
Heidenreich
Lesley H
LH
Curtis
Eric D
ED
Peterson
Gregg C
GC
Fonarow
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006339:Heart Rate / Q000502:physiology; D017051:Hospice Care / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010351:Patient Discharge; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D014481:United States / Q000453:epidemiology
D020097:Natriuretic Peptide, Brain