Author + information
- Judith E. Mitchell,
- Roseann Chesler,
- Gregg C. Fonarow,
- Shuaiqi Zhang,
- Adam DeVore,
- Roland Matsouaka,
- Marilyn Fraser,
- Nai-Lun Chang,
- Nancy M. Albert,
- Larry A. Allen and
- Clyde W. Yancy
There is a paucity of data on the patients [pts] with heart failure (HF) who leave against medical advice (AMA). We sought to identify pts and hospital characteristics and outcomes of hospitalized pts with HF who left AMA compared to pts discharged home.
Data from Get With The Guidelines-HF from Jan 2010-June 2019, and a subset of hospitalizations linked to Medicare claims between Jan 2010-Nov 2015 were analyzed. The full eligible population numbered 699,938 from 586 centers; Medicare-linked subset was 101,815 pts from 380 centers.
In total, 8747 [1.25%] of the pts left AMA. Patients leaving AMA were younger [58 vs. 72 years], more likely males [74% vs. 52%], Black [34% vs. 20%] or Hispanic (of any race) [11% vs. 8%] and more were insured by Medicaid [37% vs. 16%], all p<0.0001. Ejection fraction (%) in AMA cohort was lower: 35(17) vs. 43(17), p<0.0001. Hospital characteristics were similar except more pts who left AMA lived in the West. In the Medicare subset the readmission rates and the composite of readmission/mortality were significantly higher in the AMA pts in the first 30 days and 12 months compared to pts discharged home, p<0.001; Fig. Mortality rates were similar.
Patients leaving a HF hospitalization AMA are more likely to be younger, minority and Medicaid insured. These pts experienced substantially higher 30-day and 12-month readmission rates compare to HF pts discharged home. Strategies to identify and policies to address pts at risk for leaving AMA are warranted.
Posters Hall_Hall A
Saturday, March 28, 2020, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: Clinical 3
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1205-101
- 2020 American College of Cardiology Foundation