Initiation of domiciliary care and nursing home admission following first hospitalization of heart failure patients: a nationwide cohort study

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 Kristensen<sup>1,3

1</sup>Department 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