Profile of Patients Hospitalized for Heart Failure Who Leave Against Medical Advice

Link to article at PubMed

J Card Fail. 2021 Apr 14:S1071-9164(21)00127-5. doi: 10.1016/j.cardfail.2021.03.011. Online ahead of print.

ABSTRACT

BACKGROUND: There is a paucity of information on patients hospitalized with heart failure [HF] who leave against medical advice [AMA].

OBJECTIVES: We sought to identify patient and hospital characteristics and outcomes of patients with HF who left AMA compared to those conventionally discharged to home [CDH].

METHODS: Using the Get With The Guidelines-Heart Failure registry, data were analyzed from January 2010 to June 2019. In addition, outcomes were examined from a subset of hospitalizations with Medicare-linked claims between January 2010 and November 2015. Fully eligible population included 561,823 patients; the Medicare-linked subset included 74,502 patients.

RESULTS: In total, 8747 patients (1.56%) left AMA. The proportion of patients leaving AMA increased from 1.1 to 2.1% over the years of study. Patients leaving a HF hospitalization AMA, compared to patients CDH, were more likely younger, minorities, Medicaid covered or uninsured. The Medicare-linked subset of patients who left AMA had substantially higher 30-day and 12-month readmission rates and higher mortality at each assessment point over 12 months compared to patients who were CDH. After risk adjustments, the hazard ratio of mortality in the Medicare-linked subset AMA group compared to the CDH group was 1.25 (95% CI 1.03, 1.51), p=0.005.

CONCLUSIONS: One in 64 hospitalized patients with HF left AMA. An AMA discharge status was associated with higher risk for adverse 30 day and 12-month outcomes compared to being conventionally discharged home. Strategies that identify patients at risk of leaving AMA and policies to direct interventional strategies are warranted.

CONDENSED ABSTRACT: We investigated patient characteristics, hospital factors and clinical outcomes associated with patients leaving a HF hospitalization against medical advice compared with being conventionally discharged to home. Using GWTG, a national registry, we found that patients who left AMA were more likely to be younger, minorities, Medicaid insured or uninsured; they had higher readmission and post-discharge mortality rates. Hospital characteristics associated with higher AMA discharges were for-profit structure and Western U.S.

LOCATION: As HF prevalence increases, attention and interventions that support patients who chose to leave AMA and the hospitals from which they leave are needed.

PMID:33864931 | DOI:10.1016/j.cardfail.2021.03.011

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