Relationship between Activities of Daily Living and Readmission within 90 Days in Hospitalized Elderly Patients with Heart Failure

Abstract

Aims To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF). Methods This cohort study comprised 589 consecutive patients with HF aged ≥65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t-test, χ2 test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, and Kaplan-Meier method. Results Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission (n = 90) and readmission groups (n = 23). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups (p < 0.05). The body mass index (hazard ratio [HR]: 0.87; p < 0.05) and motor FIM score (HR: 0.94; p < 0.01) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; p < 0.001). Conclusion The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.

Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure

“…Anemia in HF patients is another possible predictor of readmission within 90 days [7,24]. In addition, low ADL and a low GNRI score were reported as features of a readmission group with heart disease [19,23]. Taken together, although the subjects of the present study had a relatively low rate of hospital readmission, they did show several characteristics related to readmission within 90 days.…”

“…The Cox proportional hazard model in the present study identified these factors as predictors of hospital readmission. Low motor FIM scores (<75 points) at discharge in hospitalized elderly patients with HF was reported to be a predictor of readmission within 90 days in a previous study [23]. Also, the motor FIM score at discharge in hospitalized HF patients undergoing rehabilitation is reported to be 60 to 70 points, and the total FIM score is 90 to 100 points [29,30].…”

“…In the Kaplan-Meier analysis, after dividing patients into the four groups based on cut-off values determined in previous studies [14,23], group 4 with a motor FIM score <75 points and GNRI <92 points had significantly lower rates of hospital readmission avoidance (log-rank test, p < 0.002) compared with the other three groups (Figure 2). In each group, the readmission avoidance rate was 90.6% for Group 1, 82.6% for Group 2, 75.7% for Group 3, and 58.3% for Group 4.…”

“…A Cox proportional hazard model for readmission within 90 days was used to ascertain whether ADL and GNRI scores were independent predictors of readmission within 90 days (hazard ratio [HR] and 95% confidence interval [CI]). The participants were classified into four groups according to the cut-off values determined in a previous study related to HF prognosis: Group 1 = motor FIM ≥75 and GNRI ≥92, Group 2 = motor FIM <75 and GNRI ≥92, Group 3 = motor FIM ≥75 and GNRI <92, and Group 4 = motor FIM <75and GNRI <92 [14,23]. Kaplan-Meier curves were constructed, and log rank tests were carried out.…”

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

“…[33] Moreover, anxiety, appetite and sleep were confirmed to be predictors of readmission for CHF in retrospective studies, which may have been impacted by the fact that the patient's status influences the risk of readmission. [34][35][36][37] Kitamura M not only confirmed that daily activities were independent predictors of readmission in heart failure patients within 90 days, but also calculated the cut-off value by ROC curve [38] and the study have also proved that self-care and daily activities are the mediating factors of readmission of heart failure. [39] While Hochang Benjamin Lee et al emphasized that personality disorders as predictors of incident cardiovascular disease increased risk disease, [40] our results are quite the opposite, which may be because the subjects studied were different; Apart from the results on patient paranoia, these findings were similar to the results of our reports on the readmission risk factors for CHF.…”