Abstract

Background

Heart failure (HF) hospitalizations are characterized by vulnerability in functioning and frequent post-discharge healthcare utilization in both acute and post-acute settings.

Objective

To determine, in patients hospitalized for decompensated HF, the association of vulnerability with (1) detailed forms of post-discharge healthcare utilization, and (2) days spent away from home after initial hospital discharge.

Design

Secondary analysis of a prospective longitudinal cohort study from a single-center academic institution in the USA.

Participants

Adults admitted with acute decompensated HF who were discharged alive.

Main Measures

The Vulnerable Elders Survey 13 (VES-13) measured functional vulnerability at baseline. The primary outcome was the Highest Healthcare Utilization (HHU) 90 days post-discharge, from the following ordered categories: at home, emergency room visit, skilled nursing facility stay, hospital readmission, or death. The secondary outcome was the proportion of days not at home (DNAH) within the first 90 days. Analyses were performed using a partial proportional odds model with adjustment for demographics and health characteristics.

Key Results

A total of 806 patients were included with median age 65, interquartile range [IQR] 55–73 years. Fewer than half (N = 345 [43%]) of patients remained alive and at home during 90-day follow-up. There were 286 [35%] hospital readmissions and 70 [8.7%] participants died. The median DNAH was 3 [IQR 0–16]. Increased vulnerability was associated with (1) HHU, (2) higher odds of utilizing healthcare or dying versus being at home alive 90 days post-discharge (OR 1.81 [95% CI, 1.35, 2.42]), and (3) higher odds of DNAH in the first 90 days (OR 1.55 [95% CI, 1.27, 1.89]).

Conclusions

In this cohort of patients hospitalized for decompensated HF, vulnerability predicted higher levels of healthcare utilization, as well as total days not at home in the 90 days following hospitalization. Vulnerability may have clinical applications to identify patients at greatest need for comprehensive, patient-centered discharge planning.

Topic

JGIM

Author Descriptions

Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
Sarah A. Welch DO, MPH

Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
Sarah A. Welch DO, MPH & Amanda S. Mixon MD, MS, MSPH, FHM

Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Chiara Di Gravio PhD

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Jonathan S. Schildcrout PhD & Yaping Shi MS

Division of General Internal Medicine and Public Health, Department of Medicine, Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
Ricardo Trochez MPH & Sunil Kripalani MD, MSc

Division of Nephrology Medicine, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt O’Brien Center for Kidney Disease, Nashville, TN, USA
Devika Nair MD, MSCI

Division of Hospital Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
Eduard E. Vasilevskis MD, MPH

Vanderbilt Center for Health Services Research, Nashville, TN, USA
Amanda S. Mixon MD, MS, MSPH, FHM & Sunil Kripalani MD, MSc

Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
Amanda S. Mixon MD, MS, MSPH, FHM

Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Susan P. Bell MD, MSCI

Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Susan P. Bell MD, MSCI

Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
Amanda S. Mixon MD, MS, MSPH, FHM & Sunil Kripalani MD, MSc

Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, USA
Sarah A. Welch DO, MPH

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