Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care

BACKGROUND: The Centers for Medicare & Medicaid Services rewards hospitals that have low 30-day risk-standardized mortality rates (RSMR) for heart failure (HF).OBJECTIVE: To describe the use of early comfort care for patients with HF, and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates.DESIGN: A retrospective, observational study.SETTING: Acute care hospitals in the United States.PATIENTS: A total of 93,920 fee-for-service Medicare beneficiaries admitted with HF from January 2008 to December 2014 to 272 hospitals participating in the Get With The Guidelines-Heart Failure registry.EXPOSURE: Early comfort care (defined as comfort care within 48 hours of hospitalization) rate.MEASUREMENTS: A 30-day RSMR.RESULTS: Hospitals’ early comfort care rates were low for patients admitted for HF, with no change over time (2.5% to 2.6%, from 2008 to 2014, P = .56). Rates varied widely (0% to 40%), with 14.3% of hospitals not initiating comfort care for any patients during the first 2 days of hospitalization. Risk-standardized early comfort care rates were not correlated with RSMR (median RSMR = 10.9%, 25th to 75th percentile = 10.1% to 12.0%; Spearman’s rank correlation = 0.13; P = .66).CONCLUSIONS: Hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day RSMR. This suggests that current efforts to lower mortality rates have not had unintended consequences for hospitals that institute early comfort care more commonly than their peers