Abstract: 170
The American Journal of Cardiology (www.ajconline.org)
time frame analysis showed a significant
drop in hospitalization rates just after PC
encounters, and continued to decrease
over time (Panel A). The annual trends
for 90-day all-cause hospitalization
rates before PC encounters showed a
significant reduction over time
(59.7% in 2010 to 53.3% in 2018, p
<0.001), but hospitalization rates
after PC remained stable over the
study period (Panel B).
In this observational nationwide
analysis of over 25,000 acute on
chronic HF admissions, PC encounters
were associated with a significant
reduction in all-cause, HF-specific, and
non-HF 90-day hospitalization rates.
This reduction was noted immediately
after discharge from the index admission with a PC encounter. Hospitalization rates before PC utilization
decreased over the study period perhaps
due to the early recognition of value of
PC among these sick patients.
This study is limited by the nature of
this administrative database which carries a risk of mis- or under-coding.
Additionally, we could not identify
patients who died after hospital discharge. Some of the reduction in readmission may be due to this factor.
However, it is unlikely that death would
account for the entire decrease
in admission rates after a hospital PC
consultation, since not all patients seen
by PC physicians are appropriate for
hospice or accept a palliative approach
to care, and the previously reported
post-HF discharge 30-day mortality
rate »7% (1). Moreover, the philosophical change of care to a palliative
approach encourages a decrease in
low-value health care utilization such
as repeat hospital admissions at the
end of life. In summary, we found that
patients who received a PC encounter
during a hospitalization had a reduction in subsequent readmission rates.
Further studies should assess the competing risk of death in this population.
Disclosure: The authors have nothing
to disclose, and no relationship with
industry.
Funding: Self-funded
Ahmed Elkaryoni, MDa,*
Brett W. Sperry, MDb
Anna Royce, MDc
Kevin Walsh, MDd
Elizabeth Bruno, MDd
Subir Shah, DOa,d
Amir Darki, MD MSca,d
Islam Y. Elgendy, MDe
a
Division of Cardiovascular Disease, Loyola
University Medical Center, Loyola Stritch School of
Medicine, Maywood, Illinois
b
Division of Cardiovascular Disease, Mid America
Heart Institute, University of Missouri-Kansas City,
Kansas City, Missouri
c
Department of Internal Medicine, University of
Oklahoma, Oklahoma
d
Department of Internal Medicine, Loyola
University Medical Center, Loyola Stritch School of
Medicine, Maywood, Illinois
e
Divison of Cardiology, Weill Cornell MedicineQatar, Doha, Qatar
27 January 2021
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