Chen, Lena M.

BACKGROUNDThe Centers for Medicare & Medicaid Services rewards hospitals that have low 30‐day risk‐standardized mortality rates (RSMR) for heart failure (HF).OBJECTIVETo 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.DESIGNA retrospective, observational study.SETTINGAcute care hospitals in the United States.PATIENTSA 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.EXPOSUREEarly comfort care (defined as comfort care within 48 hours of hospitalization) rate.MEASUREMENTSA 30‐day RSMR.RESULTSHospitals' early comfort care rates were low for patients admitted for H F, 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).CONCLUSIONSHospital 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.