Abstract 232: Determinants Of Discharge Disposition In High-risk Myocardial Infarction And Heart Failure

Abstract

Background: Discharge to home is a quality metric tracked by several health systems, payers, and certifying bodies. We examined the factors determining discharge to home versus post-acute care facilities (Nonhome) in a Medicare Fee-for-service (MFFS) population with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF). Methods: All MFFS patients who had a DRG of 280, AMI with major comorbidities (MCC), and DRG 292, ADHF with shock, complication, or comorbidity (CC), in Allegheny Health Network hospitals between 2018-2020 were included in the study. Clinical characteristics, discharge location, 30-day readmission, and 1-year mortality rates were obtained retrospectively. Results: There were 144 patients in the AMI group (56% male) and 67 patients in the ADHF group (42% male). Our MFFS numbers were lower than other metropolitan areas due to our area's high use of Medicare Advantage plans. Discharge to nonhome locations occurred in 35% of AMI and 34% of ADHF patients. Lower mean age (73 vs. 77), higher functional status prior to admission, admission from home, and normal diet consumption were more likely in-home discharges in both AMI and ADHF(p<0.05). Comorbidities including hypertension, diabetes, CKD, COPD, and clinical characteristics including LVEF, NYHA class, BMI, anemia were similar between home and nonhome groups. Prior hospitalization for a cardiac cause occurred more often in home discharges only in AMI groups (53% vs. 27% p=0.004) but not in ADHF. Independent predictors of nonhome discharge in AMI and ADHF are shown in the table. No differences in 1-year mortality and 30-day readmission rates were noted between home and nonhome discharges. Conclusions: In a high-risk population of AMI with comorbidities and ADHF with shock, nonhome discharge was best predicted by functional status prior to admission. Heightened focus on physical therapy and rehab in-hospital can promote discharge to home regardless of clinical characteristics.