Healing at Home: Receipt of Home Health Care and Patient-Centered Outcomes Among Older Adults After Acute Myocardial Infarction.

This was an observational cohort, not a randomized trial. Patients who received home health care were older, more impaired, and had higher estimated 180-day mortality risk (median 6.6% vs 3.5%) than those who did not, so the groups were not comparable without adjustment. The propensity weighting did not fully balance mobility impairment, and unmeasured factors such as informal family care, adherence to preventive activities, provider referral preferences, and access to outpatient care could still affect the results. The primary outcome, days not at home, was null after adjustment. The physical health status finding was a secondary patient-centered outcome, so it should not be used to claim that home health care keeps patients out of facilities. Home health care was studied as a mixed service package. The analysis could not evaluate dose or type, so it cannot separate the contribution of skilled nursing, physical therapy, occupational therapy, home health aide, social services, or speech therapy. Days not at home were low in both groups, averaging 2.8 days for home health recipients and 2.5 days for others over 180 days, which may have made it harder to detect differences. The study excluded participants who died during the index admission, were discharged to a facility or hospice, or could not be linked to Medicare data, so it may not apply to the sickest patients or those discharged to inpatient settings. Physical and mental health status were self-reported with the SF-12, including recall of pre-AMI status during hospitalization, which can be imprecise.

The study used data from the NIH-funded SILVER-AMI study (NIH R01HL115295). All authors declared no conflict of interest.

Do not conclude that home health care after AMI keeps older adults alive and at home. The primary outcome of days not at home showed no significant adjusted difference. The physical health status finding also came from a mixed package that included skilled nursing, physical therapy, occupational therapy, home health aide, social services, and speech therapy, so the contribution of any single component cannot be separated.