Background:
Despite recent advancements in the medical management of acute and chronic Heart Failure (HF), smooth transitions of care for patients hospitalized with HF remain elusive for most health care systems. Use of home health services and other ancillary services have been promoted in recent years as a means of reducing readmission rates among HF patients, which still remain as high as 25% in the first 30 days of discharge. Using a large national database, we aimed to study the recent trends in discharge outcomes/disposition among patients discharged with HF.
Methods:
Using National Inpatient Sample, we studied all hospitalizations among patients ≥18 years with a primary diagnosis of HF from 2005 to 2011. We studied the trends in discharge disposition during this time period. Annual rates were calculated for each year (2006-2011), fitted into a log-linear model and compared using Monte Carlo permutation test to study the changes in trend. Analysis of trends in the rates of various discharge outcomes/disposition and calculation of average annual percent change were done using the Joinpoint Regression Program (v 4.0.4, National Cancer Institute, Bethesda, Maryland) in conjunction with STATA version 13.0 (College Station, TX).
Results:
An estimated 7,572,400 HF hospitalizations were identified during the study period. The mean age was 72±14 years. Of these, 51% were females and 68% were Caucasians. From 2005-2011, the inpatient mortality rate dropped from 3.78% to 3.09%, at an average annual percentage change of -3.04% (95% CI 1.5-4.6) per year (P<0.05). During the same period, the proportion of patients discharged with home health services increased at an average annual percentage change of +4.83% (95% CI 3.7-6.0) per year (P<0.05) while transfers to skilled nursing facility or intermediate care steadily increased by +1.82% (1.1-2.6) per year (P<0.05).
Conclusions:
From 2005 to 2011, there was a nationwide increase in inpatient discharge dispositions that included home health services or discharge to skilled nursing facility/intermediate care facilities. These changes reflect increasing emphasis on use of home health services as means of reducing readmissions and improving patient outcomes. Cost-benefit analyses of these services and their effects on readmissions are areas for future study.
Table 1: Trends in Discharge Disposition among patients admitted with Heart Failure in the US, 2005-2011.
|
Year |
Mortality (% hospitalizations) |
Home health (% hospitalizations) |
SNF or intermediate care transfers (% hospitalizations) |
|
2005 |
3.78% |
16.31% |
18.57% |
|
2006 |
3.48% |
17.12% |
18.35% |
|
2007 |
3.22% |
17.33% |
19.19% |
|
2008 |
3.29% |
18.83% |
19.24% |
|
2009 |
3.21% |
18.94% |
19.29% |
|
2010 |
3.09% |
20.77% |
20.02% |
|
2011 |
3.09% |
21.82% |
20.67% |
|
Average annual percent change (2005 to 2011) |
3.04* |
4.83* |
1.82* |
SNF=skilled nursing facility; *statistically significant at P<0.05.