Premium
Nursing Home Use After Implantable Cardioverter‐Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry
Author(s) -
Kramer Daniel B.,
Reynolds Matthew R.,
Normand SharonLise,
Parzynski Craig S.,
Spertus John A.,
Mor Vincent,
Mitchell Susan L.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14520
Subject(s) - medicine , hazard ratio , confidence interval , incidence (geometry) , cumulative incidence , odds ratio , implantable cardioverter defibrillator , cohort , cohort study , pediatrics , emergency medicine , physics , optics
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 ICD s between January 1, 2006, and March 31, 2010 (N = 192,483). Measurements Proportion of ICD recipients discharged to NH s 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 NH s 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.