Initiation of domiciliary care and nursing home admission following first hospitalization of heart failure patients: a nationwide cohort study
Authors Rørth R, Fosbøl EL, Kragholm K, Mogensen UM, Jhund PS, Petrie MC, Torp-Pedersen C, Gislason GH, McMurray JJV, Køber L, Kristensen SL
Received 6 February 2018
Accepted for publication 20 April 2018
Published 2 August 2018 Volume 2018:10 Pages 917—930
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Henrik Toft Sørensen
Rasmus Rørth,1 Emil L Fosbøl,1 Kristian Kragholm,2 Ulrik M Mogensen,1,3 Pardeep S Jhund,3 Mark C Petrie,3 Christian Torp-Pedersen,4 Gunnar H Gislason,5 John JV McMurray,3 Lars Køber,1 Søren L Kristensen1,3
1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark; 3BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; 4Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark; 5Department of Cardiology, Gentofte/Herlev University Hospital, Copenhagen, Denmark
Background: Heart failure (HF) has a major impact on a patient’s quality of life and functional status. This impact may be sufficiently profound to prevent independent living although how often this is the case is unknown. We examined the need for domiciliary assistance and admission to a nursing home following first HF hospitalization.
Methods: In nationwide Danish registries, we identified a cohort of patients discharged alive after a first-time HF hospitalization in the period 2008–2014 who were matched 1:5 with comparison subjects based on age and sex and followed for 5 years.
Results: We included 37,547 patients (69% men) discharged after a first-time HF-hospitalization and 187,735 comparison subjects. The 5-year incidence of initiation of domiciliary care was 24.1% [23.7%–24.6%] among HF patients and 9.2% [9.1%–9.4%] among the comparison cohort and yielded a corresponding adjusted HR of 2.02 [1.96–2.09]. Covariates associated with initiation of domiciliary support included older age (HR 1.08 [1.07–1.08] per 1 year increase in age), living alone (HR 2.09 [2.04–2.15]) and comorbidities. The 5-year incidence of nursing home admission was 3.9% [3.7%–4.0%] among HF patients and 1.7% [1.7%–1.8%] among the comparison cohort and this resulted in an adjusted HR of 1.91 [1.77–2.06]. Covariates associated with nursing home admission included older age (HR 1.10 [1.10–1.11]), living alone (HR 2.15 [2.02–2.28]) and history of stroke (HR 2.71 [2.53–2.90]).
Conclusion: Hospitalization for HF is associated with increased need for domiciliary support and nursing home admissions. Older age, living alone, and comorbidities were associated with higher risk of both outcomes.
Keywords: domiciliary care, nursing home admission, heart failure, epidemiology
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