Although many Medicare beneficiaries with heart failure (HF) are discharged with home health services, little is known about mortality and hospice use in this group.
To identify risk factors of 6-month mortality and hospice use among hospitalized HF patients who receive home health, which could inform efforts to improve palliative and hospice use for these patients.
A retrospective cohort analysis was conducted in a 100% national sample of Medicare fee-for-service beneficiaries with HF discharged with home health from 2017-2018. Multivariable Cox regression models examined factors associated with 6-month mortality and multivariable logistic regression models examined factors associated with hospice use at the time of death.
285,359 Medicare beneficiaries were hospitalized with HF and discharged with home health; 15.5% (44,174) died within 6 months. Variables most strongly associated with mortality included: age >85 years [Hazard Ratio (HR) 1.66, 95% CI 1.61-1.71], urgent/emergency hospital admission (HR 1.68, 1.61-1.76), and “serious” condition compared to “stable” condition (HR 1.64, CI 1.52-1.78). Among 44,174 decedents, 48.2% (21,284) received hospice at the time of death. Those with lower odds of hospice use at death included patients who were: <65 years [Odds Ratio (OR) 0.65, CI 0.59-0.72]; Black (OR 0.64, CI 0.59-0.68) or Hispanic race/ethnicity (OR 0.79, CI 0.72-0.88); and Medicaid-eligible (OR 0.80, CI 0.76-0.85).
Although many patients hospitalized for HF are at risk for 6-month mortality and may benefit from palliative and/or hospice services, our findings indicate under-utilization of hospice and important disparities in hospice use by race/ethnicity and socioeconomic status.

Copyright © 2023. Published by Elsevier Inc.