Hospice care referral for heart failure leads to lower hospital readmissions

Medicare beneficiaries who were hospitalized for heart failure were less likely to be readmitted within 30 days if they were referred to hospice care, according to an analysis of data from Alabama hospitals.

Within six months of hospital discharge, most of the patients who had died were not referred to receive hospice care.

Raya E. Kheirbek, MD, of the Veteran Affairs Medical Center in Washington, D.C., and colleagues published their findings in Circulation: Heart Failure on May 27.

They mentioned that approximately one-quarter of Medicare beneficiaries hospitalized for acute decompensated heart failure are readmitted within 30 days. They added that hospital readmissions cost Medicare more than $17 billion annually. As part of the Patient Protection and Affordable Care Act, hospitals are now being penalized for having higher than expected readmission rates.

In this analysis, Kheirbek et al examined Medicare beneficiaries who were discharged from 106 hospitals in Alabama with a primary diagnosis of heart failure between July 1, 1998 and Oct. 31, 2001.

Of the patients, 182 were referred for hospice care. The researchers noted that Medicare beneficiaries are eligible for hospice care if they have a life expectancy of six months or less if the illness runs its normal course.

The 30-day, all-cause readmission rates were 5 percent for patients in the hospice group and 41 percent for patients who did not receive hospice care.

Within 30 days of discharge, the mortality rates were 43 percent for patients in the hospice group and 27 percent for patients who did not receive hospice care. The 90-day mortality rates were 64 percent and 67 percent, respectively.