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Early comfort care does not affect 30-day mortality rates

Initiation of early comfort care in patients with heart failure varied widely among hospitals and was not associated with higher 30-day risk-standardized mortality rates, according to findings published in the Journal of Hospital Medicine.

“CMS rewards hospitals that have low 30-day risk-standardized mortality rates for heart failure,” Lena M. Chen, MD, MS, from University of Michigan, Ann Arbor, and colleagues wrote.

“It is possible that hospitals that more faithfully follow their dying patients’ wishes and withdraw life-prolonging interventions and provide comfort-focused care at the end of life might be unfairly penalized if such efforts resulted in higher mortality rates than other hospitals,” they added.

Chen and colleagues performed a retrospective, observational study to determine trends in use of early comfort care in hospitals for patients with HF and whether initiation of early comfort care is associated with higher 30-day mortality rates.

The study included 93,920 fee-for-service Medicare beneficiaries who were admitted to one of 272 acute care hospitals for HF between January 2008 and December 2014. They defined early comfort care as initiating comfort care within 48 hours of hospitalization.

Results showed that among patients hospitalized for HF, rates of early comfort care were low and have remained consistent over time from 2.5% in 2008 to 2.6% in 2014. Rates of early comfort care for patients admitted for HF varied greatly, ranging from 0% to 40%.

Early comfort care was not initiated for any patients in 14.3% of hospitals. No correlation was associated between risk-standardized early comfort care rates and 30-day risk-standardized mortality rates.

These data indicate that “current efforts to lower mortality rates have not had unintended consequences for hospitals that institute early comfort care more commonly than their peers,” Chen and colleagues concluded. – by Alaina Tedesco

Disclosure: Chen reports receiving support from the Agency for Healthcare Research and Quality, the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, the Blue Cross Blue Shield of Michigan Foundation’s Investigator Initiated Research Program and the National Institute on Aging. Please see study for all other authors’ relevant financial disclosures.