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Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

dc.contributor.authorWang, Jinjiao
dc.contributor.authorDietrich, Mary S.
dc.contributor.authorBell, Susan P.
dc.contributor.authorMaxwell, Cathy A.
dc.contributor.authorSimmons, Sandra F.
dc.contributor.authorKripalani, Sunil
dc.date.accessioned2020-04-27T14:00:46Z
dc.date.available2020-04-27T14:00:46Z
dc.date.issued2019-06
dc.identifier.citationWang J, Dietrich MS, Bell SP for the Vanderbilt Inpatient Cohort Study (VICS), et al Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study BMJ Open 2019;9:e024766. doi: 10.1136/bmjopen-2018-024766en_US
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/1803/9957
dc.description.abstractObjectives (1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period. Design Secondary analysis of longitudinal data from a cohort study. Participants and setting 834 older (>= 65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121). Outcome Vulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching. Results Overall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=-1.34(-2.07, -0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%-16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year. Conclusion After adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.en_US
dc.description.sponsorshipThis work was supported by the National Institute of Health, National Heart, Lung, and Blood Institute (R01 HL109388-06) to SK; National Institute on Aging (K23 AG048347-03) to SPB; the Vanderbilt University School of Nursing Post-Doctoral Fund to JW, and in part by grant 2 UL1 TR000445-06 from the National Center for Advancing Translational Sciences.en_US
dc.language.isoen_USen_US
dc.publisherBMJ Openen_US
dc.rights© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
dc.source.urihttps://bmjopen.bmj.com/content/9/1/e024766
dc.subjectCOMPREHENSIVE GERIATRIC ASSESSMENTen_US
dc.subjectHOME HEALTH-CAREen_US
dc.subjectFUNCTIONAL DECLINEen_US
dc.subjectHEART-FAILUREen_US
dc.subjectFRAILTY TRANSITIONSen_US
dc.subjectELDERS SURVEYen_US
dc.subjectADULTSen_US
dc.subjectDISABILITYen_US
dc.subjectPEOPLEen_US
dc.subjectREADMISSIONen_US
dc.titleChanges in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1136/bmjopen-2018-024766


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