Determinants of survival and hospitalization in older, heart failure patients receiving home healthcare

• Published in: International journal of cardiology Vol. 207; pp. 145 - 149
• Main Authors: Muñoz, M.A, Real, J, Del Val, J.L, Vinyoles, E, Mundet, X, Frigola-Capell, E, Llauger, M.A, Orfila, F, Domingo, M, Verdú-Rotellar, J.M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 15-03-2016
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Cardiovascular; Cohort Studies; Electronic Health Records - trends; Female; Follow-Up Studies; Heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - therapy; Home Care Services - trends; Home healthcare; Hospital admission; Hospitalization - trends; Humans; Male; Mortality; Older; Primary care; Retrospective Studies; Risk Factors; Spain - epidemiology; Survival Rate - trends; Heart failure; Primary care; Mortality; Hospital admission; Home healthcare; Older
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.01.170

Abstract Introduction Since reported evidence is both scarce and controversial, the objective of this study is to determine the risk factors involved in the prognosis of older patients with heart failure (HF) receiving home healthcare from primary care professionals. Methods Retrospective cohort community study was carried out in 52 primary healthcare centers in Barcelona (Spain). A follow-up was performed between January 2009 and December 2012 with 7461 HF patients aged > 64 years. Information was obtained from primary care electronic medical records containing clinical data, functional and cognitive status, total mortality, and hospital admissions for cardiovascular events. Results Mortality and hospitalization during follow-up were higher in older, HF patients who received home healthcare than those who did not (HR 1.39, 95% CI 1.22–1.58 and 1.92 95% CI 1.72–2.14, respectively). The most relevant determinants for mortality were male gender (HR 1.40, 95%CI 1.10–1.79), previous hospital admission for HF (HR 1.29 95%CI 1.05–1.60), and severe dependence in activities for daily living (ADL) (HR 1.33, 95%CI 1.06–1.67). In contrast, severely dependent ADL patients were not more frequently hospitalized as a consequence of cardiovascular events (0.97, 95% CI 0.77–1.23). Conclusions Due to their greater comorbidity and age, mortality and hospitalization in patients requiring home healthcare were higher than those who did not. Among the HF patients receiving home care, mortality and hospital admissions were higher in men, older patients, and in those previously hospitalized for HF. Severe dependence in ADL determined a higher mortality but was not related to increased hospital admission rates.