Nursing Home Admission and Initiation of Domiciliary Care Following Infective Endocarditis

Eva Havers-Borgersen,Emil L Fosbøl,Rasmus Rørth,Kristian Kragholm,Søren L Kristensen,Henning Bundgaard,Niels Eske Bruun,Lauge Østergaard,Mohsin Aslam,Nana Valeur,Gunnar H Gislason,Christian Torp-Pedersen,Lars Køber,Jawad H Butt

doi:10.1016/j.gheart.2019.01.002

Abstract

BackgroundInfective endocarditis (IE) may cause debilitating physical and mental changes that can interfere with activities of daily living. Admission to a nursing home and need for domiciliary care following hospitalization for IE represent such relevant outcomes, yet no such data have been reported. MethodsUsing Danish nationwide registries, we identified all patients discharged alive after a first-time IE hospitalization in the period 1996 to 2014. These were matched by age, sex, calendar year, and relevant comorbidities with the background population in a 1:1 ratio. The 1-year rate of nursing home admission and initiation of domiciliary care, respectively, were assessed by multivariable Cox regression analyses. ResultsIn total, 4,493 IE patients were matched with 4,493 control subjects from the background population (median age: 66.8 years; interquartile range: 54.1, 76.7; 67.8% men). The 1-year incidence of nursing home admission was significantly higher among IE patients compared with the matched population (3.4% vs. 1.0%; hazard ratio: 7.95; 95% confidence interval: 4.00–15.77). Furthermore, IE patients had an increased use of domiciliary care compared with the matched population (6.6% vs. 2.1%; hazard ratio: 4.39; 95% confidence interval: 2.74–7.05). Factors associated with an increased risk of nursing home admission and domiciliary care among IE patients included older age, living alone, longer length of hospital stay, cardiovascular comorbidities, and stroke during admission. ConclusionsPatients who survived IE had an 8× higher incidence of nursing home admission and a 4× higher incidence of initiation of domiciliary care than their counterparts from the matched population.

Highlights

Infective endocarditis (IE) may cause debilitating physical and mental changes that can interfere with activities of daily living
Patients surviving IE may undergo permanent physical and mental changes, and, they may not be capable of carrying out activities of daily living or managing independently at home [7]
Factors associated with nursing home admission included advanced age, living alone, longer length of hospital admission, prior heart failure, prior pacemaker or implantable cardioverter-defibrillator, and stroke during admission (Figure 3)

Summary

Introduction

Infective endocarditis (IE) may cause debilitating physical and mental changes that can interfere with activities of daily living. Nursing home admission and mortality The 1-year cumulative incidence of nursing home admission was 3.4% among IE patients and 1.0% among control subjects (p < 0.0001) (Figure 2). IE was associated with an increased risk of nursing home admission (HR: 7.95; 95% confidence interval [CI]: 4.00e15.77; p < 0.0001). Factors associated with nursing home admission included advanced age, living alone, longer length of hospital admission, prior heart failure, prior pacemaker or implantable cardioverter-defibrillator, and stroke during admission (Figure 3). IE was associated with an increased risk of initiation of domiciliary care (HR: 4.39; 95% CI: 2.74e7.05; p < 0.0001). Factors associated with initiation of domiciliary support included older age, living alone, longer length of hospital admission, hypertension, malignancy, and stroke during admission (Online Figures 1 and 2)

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Conclusion