Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes

Jonckers, Maren; Grootven, Bastiaan Van; Willemyns, Ester; Hornikx, Miek; Jeuris, Anthony; Dubois, Christophe; Herregods, Marie‐Christine

doi:10.1080/00015385.2017.1421300

Cited by 5 publications

(12 citation statements)

References 36 publications

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“…Moreover, there was a large difference between the length of hospital stay. While the length of stay was 23 days in average for our study, it was 4 to 13 days in the previous studies [20][21][22]. Thus, patients in our study may have undergone more rehabilitation compared to patients in the previous studies, which may have contributed to the lower prevalence of HAD.…”

Section: Plos Onementioning

confidence: 50%

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Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

et al. 2021

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Background Limitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients. Aims This multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF. Methods Four hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = −1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline. Results The ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231–0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the “go out by oneself”, “travel using a bus or train”, “shop for necessities”, “vacuum”, and “manage medication” were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05). Conclusions The present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.

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Section: Plos Onementioning

confidence: 50%

“…valvular heart disease and found that 51.9% of their subjects developed HAD [20]. Other studies reported the prevalence of HAD as 41% and 33% among older adults admitted to general medicine and cardiac care unit, respectively [21,22].…”

Section: Plos Onementioning

confidence: 98%

Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

et al. 2021

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“…This theory was developed by integrating evidence from (1) a systematic review and meta-analysis on the effectiveness of geriatric co-management programmes, 18 (2) an international Delphi study that aimed to find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes 21 and (3) an exploratory prospective cohort study in hospitalised patients with cardiac conditions to determine the incidence of in-hospital functional decline, the associated risk factors and the link with care processes. 22 Additionally, we developed a clinical prediction model that identifies patients who are at risk for developing functional decline during hospitalisation. This risk prediction model was built based on data from the precohort of this intervention study, and will be used to identify patients in need for geriatric co-management, that is, patients with an increased risk for functional decline (submitted manuscript).…”

Section: Methodsmentioning

confidence: 99%

“…We assumed a minimal important difference of 1 mean point on the Katz ADL and a SD of 3 points on the Katz ADL with equal groups, based on observations in a pilot study. 22 This equals a standardised effect size of 0.33 (Cohen’s d) and indicates a low-to-moderate effect size. Therefore, a total of 159 patients are needed per group (α=0.05, Power=0.8, two-sided test), accounting for 10% missing data.…”

Section: Methodsmentioning

confidence: 99%

Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study

et al. 2018

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IntroductionAlthough the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs of frail older patients. Geriatric co-management has demonstrated potential to improve functional status, and reduce complications and length of stay, but evidence on the effectiveness in cardiology patients is lacking. This study aims to determine if geriatric co-management is superior to usual care in preventing functional decline, complications, mortality, readmission rates, reducing length of stay and improving quality of life in older patients admitted for acute heart disease or for transcatheter aortic valve implantation, and to identify determinants of success for geriatric co-management in this population.Methods and analysisThis prospective quasi-experimental before-and-after study will be performed on two cardiology units of the University Hospitals Leuven in Belgium in patients aged ≥75 years. In the precohort (n=227), usual care will be documented. A multitude of implementation strategies will be applied to allow for successful implementation of the model. Patients in the after cohort (n=227) will undergo a comprehensive geriatric assessment within 24 hours of admission to stratify them into one of three groups based on their baseline risk for developing functional decline: low-risk patients receive proactive consultation, high-risk patients will be co-managed by the geriatric nurse to prevent complications and patients with acute geriatric problems will receive an additional medication review and co-management by the geriatrician.Ethics and disseminationThe study protocol was approved by the Medical Ethics Committee UZ Leuven/KU Leuven (S58296). Written voluntary (proxy-)informed consent will be obtained from all participants at the start of the study. Dissemination of results will be through articles in scientific and professional journals both in English and Dutch and by conference presentations.Trial registration numberNCT02890927.

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“…We assumed a minimal important difference (MID) of one point on the Katz ADL between the intervention groups at hospital discharge, with a standard deviation of three points (based on observations in a pilot study). 11 Accounting for 10% missing data, 159 patients were needed per group (alpha = 0.05, power = 0.8, two-sided test). We aimed to recruit 227 patients per group because we expected that 30% of recruited patients would be at low risk for functional decline and not be eligible for follow-up.…”

Section: Sample Sizementioning

confidence: 99%

Geriatric co‐management for cardiology patients in the hospital: A quasi‐experimental study

Grootven

Jeuris

Jonckers

et al. 2021

J American Geriatrics Society

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Background/Objectives: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. Design: A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. Setting: Two cardiac care units of the University Hospitals Leuven.Participants: One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention: A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS:The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; onepoint difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS:The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5,

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Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes

Abstract: Half of the older adults with VHD developed HAD. The results indicate a potential association between HAD and care processes, which could be used as quality measures and intervention targets. Validation in larger cohort studies is recommended.

Cited by 5 publications

References 36 publications

Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study

Geriatric co‐management for cardiology patients in the hospital: A quasi‐experimental study

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