Home care utilization and outcomes among Asian and other Canadian patients with heart failure

Guanmin Chen,Brenda R Hemmelgarn,Hude Quan,Kathryn M King,Nadia Khan

doi:10.1186/1471-2261-10-12

Abstract

BackgroundHeart failure (HF) is a major cause of hospitalization and death in the aging population around the world. Home care utilization is associated with improved survival for the patients with HF, and varies by ethno-culture. The purpose of this study was to investigate the difference in hospital readmission rate and mortality between Asian and other Canadian HF patients.MethodsHF patients were identified using hospital discharge abstracts from March 31, 2000 to April 1, 2006 in Calgary Health Region. Readmission and one-year mortality for HF were determined by linking hospital discharge and vital statistics data. Stratified by home care services use, readmission and mortality rates were compared between the Asians and other Canadians while controlling for age, sex, comorbidities, and household income.ResultsOf 26,171 HF patients discharged from hospital, 56.6% of Asians and 58.0% of other Canadians used home care services [adjusted odds ratio (OR) for Asian: 0.84, 95% confidence interval (CI): 0.74-0.89]. The hospital readmission rate was similar between Asians and other Canadians regardless of home care services use. Mortality was similar between those who used home care services (adjusted OR for Asian: 0.96, 95% CI: 0.81-1.13). For patients who did not use home care services, Asians had significantly lower mortality than other Canadians (adjusted OR for Asian: 0.76, 95% CI: 0.60-0.86).ConclusionMortality was similar between Asian and other Canadian patients when home care services were utilized. However, among those without home care, Asian patients had a significantly lower mortality than other Canadian patients.

Highlights

Heart failure (HF) is a major cause of hospitalization and death in the aging population around the world
After adjustment for sex, age, annual household income and Charlson Index Score, Asian patients were less likely to utilize home care service than other Canadian patients (Table 2)
There were no significant differences for home care utilization between Asian and other Canadian male patients, those who were less than 75 years old, or those who had an

Summary

Introduction

Heart failure (HF) is a major cause of hospitalization and death in the aging population around the world. Because of the aging population and greater survival of HF patients[4,5], more people with HF and its complications will require more home care and communitybased services; potentially generating additional burdens. Findings from previous research indicate that Black, Hispanic, and some Asian American populations have higher rates of chronic disease[8], are less likely to utilize health care, and experience more barriers of access to healthcare system than Whites[9]. Black, Hispanic and Asian Americans have lower nursing home services utilization[10,11], the ethnic users consume home care resources more intensively than White users[12,13]. A United States based study of patients in a nursing home demonstrates that elderly Asian Americans patients rely more heavily on family members to provide medical decision-making than other populations [10]

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