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- Title
Nursing Home Use After Implantable Cardioverter-Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry.
- Authors
Kramer, Daniel B.; Reynolds, Matthew R.; Normand, Sharon‐Lise; Parzynski, Craig S.; Spertus, John A.; Mor, Vincent; Mitchell, Susan L.
- Abstract
Objectives To evaluate the incidence and characteristics of nursing home (NH) use after implantable cardioverter-defibrillator (ICD) implantation. Design Cohort study. Setting Medicare beneficiaries in the National Cardiovascular Data Registry- ICD Registry. Participants Individuals aged 65 and older receiving ICDs between January 1, 2006, and March 31, 2010 (N = 192,483). Measurements Proportion of ICD recipients discharged to NHs directly after device placement, cumulative incidence of long-term NH admission, and factors associated with immediate discharge to a NH and time to long-term NH admission. Results Over 4 years, 40.6% of the cohort died, and 35,939 (18.7%) experienced at least one NH admission, including 4.0% directly discharged to a NH after ICD implantation and 2.8% admitted to long-term NH care during follow-up. The cumulative incidence of long-term NH admission, accounting for the competing risk of death, was 1.7% at 1 year, 3.8% at 3 years, and 4.6% at 4 years; 20.1% of individuals admitted to a NH died there. Factors most strongly associated with direct NH discharge and time to long-term NH care were older age (adjusted odds ratio (AOR) = 2.09, 95% confidence interval ( CI) = 2.01-2.17 per 10-year increment; adjusted hazard ratio (AHR) = 1.88, 95% CI = 1.80-1.97, respectively), dementia (AOR = 2.60, 95% CI = 2.25-3.01; AHR = 2.50, 95% CI = 2.14-2.93, respectively), and Medicare Part A claim for NH stay in prior 6 months (AOR = 3.96, 95% CI = 3.70-4.25; AHR = 2.88, 95% CI = 2.65-3.14, respectively). Conclusion Nearly one in five individuals are admitted to NHs over a median of 1.6 years of follow-up after ICD implantation. Understanding these outcomes may help inform the clinical care of these individuals.
- Subjects
NURSING home care; IMPLANTABLE cardioverter-defibrillators; ELDER care; CARDIOVASCULAR diseases in old age; CARDIOVASCULAR disease treatment
- Publication
Journal of the American Geriatrics Society, 2017, Vol 65, Issue 2, p340
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.14520