Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

Madeline R Sterling; Lisa M Kern; Monika M Safford; Christine D Jones; Penny H Feldman; Gregg C Fonarow; Shubin Sheng; Roland A Matsouaka; Adam D DeVore; Barbara Lytle; Haolin Xu; Larry A Allen; Anita Deswal; Clyde W Yancy; Nancy M Albert

doi:10.1016/j.jchf.2020.06.009

Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

JACC Heart Fail. 2020 Dec;8(12):1038-1049. doi: 10.1016/j.jchf.2020.06.009. Epub 2020 Aug 12.

Authors

Affiliations

¹ Weill Cornell Medicine, New York, New York, USA. Electronic address: mrs9012@med.cornell.edu.
² Weill Cornell Medicine, New York, New York, USA.
³ University of Colorado School of Medicine, Aurora, Colorado, USA.
⁴ Visiting Nurse Service of New York, New York, New York, USA.
⁵ University of California Los Angeles, Los Angeles, California, USA.
⁶ Duke Clinical Research Institute, Durham, North Carolina, USA.
⁷ Duke University, Durham, North Carolina, USA.
⁸ University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁹ Northwestern University, Chicago, Illinois, USA.
¹⁰ Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

Objectives: This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates.

Background: After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied.

Methods: This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes.

Results: From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC.

Conclusions: Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.

Keywords: heart failure; home health care; mortality; readmission.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Aged
Female
Heart Failure* / epidemiology
Heart Failure* / therapy
Home Care Services*
Hospitalization
Humans
Male
Medicare
Patient Discharge
Patient Readmission
United States / epidemiology

Grants and funding

K23 HL150160/HL/NHLBI NIH HHS/United States