Abstract 4347517: Potential Patient Eligibility for Hospital at Home for Management of Worsening Heart Failure in the United States

Abstract

Introduction/Background: Hospital at Home (HaH) is an emerging, patient-centered clinical model by which patients receive inpatient-level care at home. HaH may be particularly well-suited to the care of patients with worsening heart failure (WHF). Research Questions: Our study sought to examine, if implemented widely, what proportion of US patients hospitalized with WHF would be eligible for HaH care. We also sought to determine the clinical and demographic differences between HaH eligible and ineligible populations. Methods/Approach: Among US patients hospitalized for WHF in the Get With The Guidelines – Heart Failure (GWTG-HF) registry from 2021-2024, we applied generally accepted and/or required (by Medicare) social and clinical criteria for HaH to estimate the proportion of patients potentially eligible for HaH. We then further compared the demographics, vital signs and laboratory findings, comorbidities, mortality, and length of stay for the HaH eligible and ineligible groups. Results/Data: Among 81,610 patients hospitalized across 204 sites, 49,544 (60.7%) were projected as eligible for HaH (Table 1) . Eligibility rates were >50% across demographic and geographic subgroups but tended to be higher among patients age >75 years, women, and Hispanic patients, as well as among patients hospitalized in urban areas and the Northeast US (Figure) . Eligible patients were less likely to have a history of chronic kidney disease and had a lower median GWTG-HF risk score (Table 2) . Patients eligible for HaH had lower in-hospital mortality and shorter length of stay (Table 2) . Conclusions: In this nationwide cohort of US patients hospitalized for WHF, approximately 6 out of 10 patients were projected as potentially eligible for HaH, with modest variability across demographic and geographic subgroups. Patients eligible for HaH demonstrated a lower risk clinical profile. HaH could conceivably be a viable treatment strategy for the majority of US patients with WHF, and national efforts to continue or expand HaH have the potential to substantially impact WHF care delivery.