Premium
Impact of home‐ and community‐based services in the long‐term care insurance system on outcomes of patients with acute heart failure: Insights from the Kitakawachi Clinical Background and Outcome of Heart Failure Registry
Author(s) -
Takabayashi Kensuke,
Fujita Ryoko,
Iwatsu Kotaro,
Ikeda Tsutomu,
Morikami Yuko,
Ichinohe Tahei,
Yamamoto Takashi,
Takenaka Kotoe,
Okuda Miyuki,
Nakajima Osamu,
Koito Hitoshi,
Terasaki Yuka,
Kitamura Tetsuhisa,
Kitaguchi Shouji,
Nohara Ryuji
Publication year - 2020
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.14013
Subject(s) - medicine , heart failure , outcome (game theory) , intensive care medicine , term (time) , gerontology , emergency medicine , physics , mathematics , mathematical economics , quantum mechanics
Aim In Japan, the long‐term care insurance (LTCI) system is important for elderly people living at home; however, no clinical studies have revealed a relationship between home‐ or community‐based services and outcomes in patients with acute heart failure (AHF). Methods This was a prospective multicenter cohort study of patients with AHF enrolled between April 2015 and August 2017. Patients aged ≥65 years with LTCI were divided into those receiving home‐ and community‐based services (service users) and without home and community‐based services (service non‐users). The endpoint was defined as a composite endpoint, which included all‐cause mortality and hospitalization for heart failure after discharge. Subgroup analyses were performed for elderly patients (<85 years) or super‐elderly patients (≥85 years). Results The study participants were eligible for LTCI two times more than community‐dwelling people were. At the 1‐year follow‐up period, the rate of the composite endpoint showed no significant difference between service users and service non‐users among all patients or super‐elderly patients. However, in elderly patients, the rate of the composite endpoint was significantly lower among service users than service non‐users. The difference was independently maintained even after adjustments for differences in comorbidities or in social backgrounds (adjusted hazard ratio 0.62; 95% confidence interval 0.38–0.99, and adjusted hazard ratio 0.57; 95% confidence interval 0.35–0.90, respectively). Conclusions In this study, adverse events following discharge of patients with AHF who used home‐ and community‐based services were prevented only in elderly patients, not in super‐elderly patients. Geriatr Gerontol Int 2020; 20: 967–973 .