Table 1. Characteristics of Patients With Heart Failure (HF) Discharged to Hospice, Patients With Advanced HF, and Other Patients With HF in the Get With The Guidelines–HF Registry.
| Variable | % | P Value | ||
|---|---|---|---|---|
| Hospice (n = 4588) | Advanced HF (n = 4357)a | Other HF (n = 113 045) | ||
| Demographic Characteristics | ||||
| Age, median (IQR), y | 86 (80-90) | 78 (72-84) | 81 (74-87) | <.001 |
| Female | 2555 (55.7) | 1458 (33.5) | 62 404 (55.2) | <.001 |
| Race | <.001 | |||
| White | 3957 (88.1) | 3414 (79.7) | 90 541 (81.8) | |
| Black | 263 (5.9) | 493 (11.5) | 10 785 (9.7) | |
| Hispanic (any race) | 137 (3.1) | 193 (4.5) | 4941 (4.5) | |
| Asian | 44 (1.0) | 60 (1.4) | 1419 (1.3) | |
| Other (includes UTD) | 88 (2.0) | 123 (2.9) | 3032 (2.7) | |
| Insurance | <.001 | |||
| No insurance/ND/UTD | 10 (0.3) | 10 (0.3) | 304 (0.3) | |
| Medicare | 2756 (76.3) | 2914 (73.3) | 70 374 (75.9) | |
| Medicaid | 161 (4.5) | 204 (5.1) | 5258 (5.7) | |
| Other | 684 (18.9) | 848 (21.3) | 16 750 (18.1) | |
| Median household income, median (IQR), × $1000 in 2015 US $ | 51.4 (45.4-60.7) | 51.2 (44.6-60.7) | 51.9 (45.6-60.8) | .002 |
| High school degree, median (IQR), % | 88.1 (85.0-90.8) | 87.3 (83.5–90.0) | 87.4 (83.9-90.4) | <.001 |
| Unemployment rate, median (IQR), % | 7.0 (5.8-8.2) | 7.1 (5.9-8.6) | 7.1 (5.9-8.3) | .001 |
| EF, median (IQR), % | 40 (25-56) | 20 (15-25) | 49 (33-60) | <.001 |
| Medical History | ||||
| Atrial flutter/fibrillation | 1974 (46.0) | 1739 (41.0) | 43 627 (41.6) | <.001 |
| COPD or asthma | 1311 (30.5) | 1140 (26.9) | 30 665 (29.2) | .001 |
| Diabetes | 1420 (33.1) | 1806 (42.6) | 41 284 (39.3) | <.001 |
| Hyperlipidemia | 1865 (43.5) | 2102 (49.5) | 52 131 (49.7) | <.001 |
| Hypertension | 3136 (73.1) | 2915 (68.7) | 82 124 (78.3) | <.001 |
| Peripheral vascular disease | 586 (13.7) | 661 (15.6) | 13 620 (13.0) | <.001 |
| CAD | 2184 (50.9) | 2569 (60.5) | 53 357 (50.8) | <.001 |
| Prior MI | 815 (19.0) | 1132 (26.7) | 18 768 (17.9) | <.001 |
| CVA/TIA | 797 (18.6) | 633 (14.9) | 17 292 (16.5) | <.001 |
| ICD only | 308 (7.2) | 988 (23.3) | 6473 (6.2) | <.001 |
| HF | 2916 (67.9) | 2841 (67.0) | 61 598 (58.7) | <.001 |
| Anemia | 1074 (25.0) | 810 (19.1) | 20 544 (19.6) | <.001 |
| Pacemaker | 682 (15.9) | 775 (18.3) | 15 778 (15.0) | <.001 |
| Dialysis, chronic | 75 (1.7) | 130 (3.1) | 3163 (3.0) | <.001 |
| Renal insufficiency, chronic (serum creatinine level >2.0 mg/dL) | 1209 (28.2) | 1350 (31.8) | 20 948 (20.0) | <.001 |
| Depression | 545 (12.7) | 383 (9.0) | 11 304 (10.8) | <.001 |
| Valvular heart disease | 1042 (24.3) | 806 (19.0) | 17 485 (16.7) | <.001 |
| Smoking | 230 (5.4) | 409 (9.4) | 9587 (8.6) | <.001 |
| Symptoms | ||||
| Admission symptoms | ||||
| Chest pain | 227 (10.9) | 443 (13.4) | 9085 (16.2) | <.001 |
| Decreased appetite/early satiety | 186 (8.9) | 240 (7.2) | 2187 (3.9) | <.001 |
| Dizziness/lightheadedness/syncope | 125 (6.0) | 234 (7.1) | 3268 (5.8) | .01 |
| Dyspnea at rest | 1135 (54.6) | 1535 (46.3) | 26 935 (47.9) | <.001 |
| Dyspnea on exertion | 1169 (56.2) | 2179 (65.8) | 34 928 (62.2) | <.001 |
| Fatigue | 534 (25.7) | 920 (27.8) | 11 219 (20.0) | <.001 |
| Orthopnea | 411 (19.8) | 901 (27.2) | 13 130 (23.4) | <.001 |
| PND | 164 (7.9) | 404 (12.2) | 5337 (9.5) | <.001 |
| Admission symptoms missing | 2508 (54.7) | 1045 (24.0) | 56 860 (50.3) | <.001 |
| Discharge symptoms | <.001 | |||
| Unable to determine | 256 (12.2) | 286 (8.7) | 4630 (8.4) | |
| Better, asymptomatic | 277 (13.2) | 1467 (44.9) | 27 612 (50.4) | |
| Better, symptomatic | 822 (39.3) | 1444 (44.2) | 21 991 (40.1) | |
| Unchanged | 365 (17.4) | 60 (1.8) | 481 (0.9) | |
| Worse | 372 (17.8) | 12 (0.4) | 96 (0.2) | |
| No parental therapy | 651 (20.9) | 1062 (26.6) | 27 179 (34.2) | <.001 |
| No in-hospital procedures | 2560 (88.6) | 2577 (66.9) | 59 575 (79.3) | <.001 |
| Advanced care | ||||
| Advanced care plan/surrogate decision maker | 1657 (75.6) | 785 (61.5) | 29 353 (66.0) | <.001 |
| Advance directive executed | 106 (71.1) | 139 (40.6) | 4919 (40.1) | <.001 |
| HF reporting: advanced care plan | 2373 (51.7) | 1532 (35.2) | 51 101 (45.2) | <.001 |
| Hospital characteristics | ||||
| Rural location | 215 (4.8) | 246 (6.0) | 6288 (5.9) | .01 |
| Teaching status | 3117 (69.3) | 3166 (73.8) | 78 314 (70.6) | <.001 |
| Heart transplant hospital | 325 (9.8) | 449 (16.1) | 7153 (9.6) | <.001 |
Abbreviations: CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; EF, ejection fraction; ICD, implantable cardioverter defibrillator; IQR, interquartile range; MI, myocardial infarction; ND, not determined; PND; paroxysmal nocturnal dyspnea; UTD, unable to determine.
a
Patients with advanced HF were defined as ejection fraction of 25% or less and any of the following: inpatient inotrope use, serum sodium level of 130 mEq/L or less, blood urea nitrogen level of 45 mg/dL or more [to convert to micromoles per liter, multiply by 0.357], systolic blood pressure of 90 mm Hg or less, or comfort measures during hospitalization.