• Raya E Kheirbek, Ross D Fletcher, Marie A Bakitas, Gregg C Fonarow, Sridivya Parvataneni, Donna Bearden, Frank A Bailey, Charity J Morgan, Steven Singh, Marc R Blackman, Michael R Zile, Kanan Patel, Momanna B Ahmed, Rodney O Tucker, Cynthia J Brown, Thomas E Love, Wilbert S Aronow, Jeffrey M Roseman, Michael W Rich, Richard M Allman, and Ali Ahmed.
• From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.).
• Circ Heart Fail. 2015 Jul 1;8(4):733-40.

BackgroundHeart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown.Methods And ResultsOf the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998-2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years; 58% women; 18% non-white). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio associated with hospice referral, 0.12; 95% confidence interval, 0.06-0.24). Hazard ratios (95% confidence intervals) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post discharge were 0.03 (0.04-0.21) and 0.17 (0.08-0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% versus 27%), it was similar at 90 days (64% versus 67% among hospice-eligible patients).ConclusionsA discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized patients with HF. However, most patients with HF who died within 6 months of hospital discharge did not receive a discharge hospice referral.© 2015 American Heart Association, Inc.

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