Outcomes in heart failure patients discharged to skilled nursing facilities with delirium
Abstract Aim Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and deli...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13895 |
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| author | Jacob Lafo Mriganka Singh Lan Jiang Stephen Correia Caroline Madrigal Rachel Clements Wen‐Chih Wu Sebhat Erqou James L. Rudolph |
| author_facet | Jacob Lafo Mriganka Singh Lan Jiang Stephen Correia Caroline Madrigal Rachel Clements Wen‐Chih Wu Sebhat Erqou James L. Rudolph |
| author_sort | Jacob Lafo |
| collection | DOAJ |
| description | Abstract Aim Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. Methods and results The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre‐existing dementia was identified based on International Classification of Diseases‐9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (−) of dementia and delirium. Relative to the dementia−/delirium− group, the dementia−/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia−/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium−/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. Conclusions Delirium, independent of pre‐existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs. |
| format | Article |
| id | doaj-art-3bde9fc1154d487c852710783d4ea7f4 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-3bde9fc1154d487c852710783d4ea7f42025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931891190010.1002/ehf2.13895Outcomes in heart failure patients discharged to skilled nursing facilities with deliriumJacob Lafo0Mriganka Singh1Lan Jiang2Stephen Correia3Caroline Madrigal4Rachel Clements5Wen‐Chih Wu6Sebhat Erqou7James L. Rudolph8Providence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAProvidence VA Medical Center Center of Innovation in Long Term Services and Supports 830 Chalkstone Avenue Providence RI 02908 USAAbstract Aim Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. Methods and results The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre‐existing dementia was identified based on International Classification of Diseases‐9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (−) of dementia and delirium. Relative to the dementia−/delirium− group, the dementia−/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia−/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium−/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. Conclusions Delirium, independent of pre‐existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs.https://doi.org/10.1002/ehf2.13895Heart failureRehabilitationDeliriumDementiaMortalitySkilled nursing facilities |
| spellingShingle | Jacob Lafo Mriganka Singh Lan Jiang Stephen Correia Caroline Madrigal Rachel Clements Wen‐Chih Wu Sebhat Erqou James L. Rudolph Outcomes in heart failure patients discharged to skilled nursing facilities with delirium ESC Heart Failure Heart failure Rehabilitation Delirium Dementia Mortality Skilled nursing facilities |
| title | Outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| title_full | Outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| title_fullStr | Outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| title_full_unstemmed | Outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| title_short | Outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| title_sort | outcomes in heart failure patients discharged to skilled nursing facilities with delirium |
| topic | Heart failure Rehabilitation Delirium Dementia Mortality Skilled nursing facilities |
| url | https://doi.org/10.1002/ehf2.13895 |
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