Inpatient palliative care referral and 9-month hospital readmission in patients with congestive heart failure: a linked nationwide analysis.

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Inpatient palliative care referral and 9-month hospital readmission in patients with congestive heart failure: a linked nationwide analysis.

J Intern Med. 2017 Jul 25;:

Authors: Wiskar K, Celi LA, Walley KR, Fruhstorpher C, Rush B

Abstract
OBJECTIVE: End-stage heart failure (HF) is characterized by high symptom burden and frequent hospitalization. Palliative Care (PC) is recommended for advanced HF, and there is some evidence in other diseases that this may reduce readmission rates. We attempted examine the association of an inpatient PC visit on hospital readmission for patients admitted with HF.
METHODS: Retrospective linked nationwide analysis from 2013 with 9-month follow-up for all hospital readmissions for patients admitted with HF exacerbations using the Nationwide Readmission Database (NRD). The NRD gathers all hospital admissions for patients from 22 states and tracks patients throughout the year, allowing for examination of readmission statistics. A propensity score model for PC visit was made and patients were matched in a 1:1 fashion.
RESULTS: There were 102,746 patients who survived an admission for HF in the first 3 months of 2013. Of these, 2,287 (2.2%) patients had a PC visit as inpatients. After matching based on propensity for a PC visit during the index hospitalization, 2,282 patients who received a PC visit were matched to 2,282 patients who did not. Those receiving a PC visit were less likely to be readmitted for HF (9.3% vs 22.4%, p<0.01) or for any cause (29.0% vs 63.2%, p<0.01) during the 9-month follow-up period. The average hospital charges during the follow-up period for the non-PC cohort were $77,643 per patient. The average charges for PC patients was $23,200 (p<0.01).
CONCLUSIONS: Patients with HF who received an inpatient PC visit had significantly lower rates of all-cause and HF-specific readmission in the subsequent 9 months. Total 9-month hospital charges were also significantly lower for patients who received an inpatient PC visit. This article is protected by copyright. All rights reserved.

PMID: 28741859 [PubMed - as supplied by publisher]

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