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Kheirbek RE, Fletcher RD, Bakitas MA, Fonarow GC, Parvataneni S, Bearden D, Bailey FA, Morgan CJ, Singh S, Blackman MR, Zile MR, Patel K, Ahmed MB, Tucker RO, Brown CJ, Love TE, Aronow WS, Roseman JM, Rich MW, Allman RM, Ahmed A. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure. Circ Heart Fail 2015; 8:733-40. [PMID: 26019151 DOI: 10.1161/circheartfailure.115.002153] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/11/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. METHODS AND RESULTS Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998-2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years; 58% women; 18% non-white). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio associated with hospice referral, 0.12; 95% confidence interval, 0.06-0.24). Hazard ratios (95% confidence intervals) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post discharge were 0.03 (0.04-0.21) and 0.17 (0.08-0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% versus 27%), it was similar at 90 days (64% versus 67% among hospice-eligible patients). CONCLUSIONS A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized patients with HF. However, most patients with HF who died within 6 months of hospital discharge did not receive a discharge hospice referral.
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Affiliation(s)
- Raya E Kheirbek
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Ross D Fletcher
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Marie A Bakitas
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Gregg C Fonarow
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Sridivya Parvataneni
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Donna Bearden
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Frank A Bailey
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Charity J Morgan
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Steven Singh
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Marc R Blackman
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Michael R Zile
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Kanan Patel
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Momanna B Ahmed
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Rodney O Tucker
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Cynthia J Brown
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Thomas E Love
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Wilbert S Aronow
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Jeffrey M Roseman
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Michael W Rich
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Richard M Allman
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.)
| | - Ali Ahmed
- From the Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., S.S., M.R.B., A.A.); Department of Medicine, George Washington University, Washington, DC (R.E.K., M.R.B.); Department of Medicine, Georgetown University, Washington, DC (R.D.F., S.S., M.R.B., A.A.); School of Nursing (M.A.B.) and Departments of Medicine (M.A.B., D.B., M.B.A., R.O.T., C.J.B., A.A.), Biostatistics (C.J.M.), and Epidemiology (J.M.R.), University of Alabama at Birmingham; Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, East Tennessee State University, Johnson City (S.P.); Department of Medicine, University of Colorado, Denver (F.A.B.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Department of Medicine, University of California, San Francisco (K.P.); Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (C.J.B.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); Department of Medicine, Washington University, St. Louis, MO (M.W.R.); and Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, DC (R.M.A.).
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