Welch Sarah A, Di Gravio Chiara, Schildcrout Jonathan S, Trochez Ricardo, Shi Yaping, Nair Devika, Vasilevskis Eduard E, Mixon Amanda S, Bell Susan P, Kripalani Sunil
Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
J Gen Intern Med. 2025 Feb;40(3):547-555. doi: 10.1007/s11606-024-08872-x. Epub 2024 Sep 27.
Heart failure (HF) hospitalizations are characterized by vulnerability in functioning and frequent post-discharge healthcare utilization in both acute and post-acute settings.
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.
Secondary analysis of a prospective longitudinal cohort study from a single-center academic institution in the USA.
Adults admitted with acute decompensated HF who were discharged alive.
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.
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]).
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.
心力衰竭（HF）住院患者的特点是功能脆弱，在急性和急性后环境中出院后经常需要医疗保健服务。
确定因失代偿性HF住院的患者中，脆弱性与（1）出院后医疗保健利用的详细形式，以及（2）首次出院后离家天数之间的关联。
对美国一家单中心学术机构的前瞻性纵向队列研究进行二次分析。
因急性失代偿性HF入院且存活出院的成年人。
脆弱老年人调查13（VES-13）在基线时测量功能脆弱性。主要结局是出院后90天的最高医疗保健利用（HHU），来自以下有序类别：在家、急诊就诊、熟练护理机构停留、再次住院或死亡。次要结局是前90天内不在家（DNAH）的天数比例。分析采用部分比例优势模型，并对人口统计学和健康特征进行调整。
共纳入806例患者，中位年龄65岁，四分位间距[IQR]为55 - 73岁。在90天随访期间，不到一半（N = 345 [43%]）的患者存活且在家。有286例[35%]再次住院，70例[8.7%]参与者死亡。DNAH的中位数为3天[IQR 0 - 16]。脆弱性增加与（1）HHU、（2）出院后90天内利用医疗保健或死亡而非存活在家的较高几率相关（OR 1.81 [95% CI，1.35，2.42]），以及（3）前90天内DNAH的较高几率相关（OR 1.55 [95% CI，1.27，1.89]）。
在这一因失代偿性HF住院的患者队列中，脆弱性预示着更高水平的医疗保健利用，以及住院后9天内不在家的总天数。脆弱性可能在临床应用中用于识别最需要全面、以患者为中心的出院计划的患者。
