Impact of Hospice and Palliative Care Service Utilization on All-Cause 30-Day Readmission Rate for Older Adults Hospitalized with Heart Failure

Abstract

Background: Acute decompensated heart failure (HF) is the leading cause for hospital readmission. Large-scale sustainable interventions to reduce readmission rate have not been fully explored or proven effective. Objective: We studied the impact of hospice and palliative care service utilization on 30-day all-cause hospital readmissions for patients with HF. Methods and Results: Data were retrieved from the Department of Veterans Affairs Corporate Data Warehouse. The study included 238 116 HF admissions with primary diagnosis of HF belonging to 130 812 patients. Among these patients, 2592 had hospice and palliative care utilizations and 68 245 patients did not. Rehospitalization was calculated within 30 days of index hospitalization. Propensity scores were used to match hospice and nonhospice patients on demographics, Charlson comorbidity categories, and 30-day survival. In the matched group, logistic regression was used to estimate effects of hospice on readmission, controlling for any covariates that had failed to balance. The average age of the matched patients was 74 years old, 14% were African American, 75% Caucasian, 2% Asian, and 17% female. After propensity matching, the odds ratio for readmission was 1.29. The 95% confidence interval for the odds was 1.13 to 1.48, suggesting that veterans receiving services have a higher chance of readmission. Conclusion: In a large cohort study of older US Veterans, utilization of hospice and palliative care services was associated with a higher 30-day all-cause readmission rate among hospitalized patients with HF. Further prospective studies should be conducted to confirm results and test generalizability outside the Veterans Affairs system of care.