Abstract
BackgroundCardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services.MethodsThe study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006–14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF.ResultsTwo thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18–1.35), 1.53 (95%CI:1.44–1.64) and 1.39 (95%CI:1.32–1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12–1.41), 2.65 (95%CI:2.42–2.91) and 1.50 (95%CI:1.37–1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31–5.32), 3.26 (95%CI:2.91–3.65) and 4.94 (95%CI:4.47–5.46)).ConclusionsOlder people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.
Highlights
Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide
The Service Use and Adverse Health Outcomes (SHOut) project uses baseline survey data from the Sax Institute’s 45 and Up Study linked to administrative data [17]. 45 and Up Study participants were from New South Wales (NSW), Australia, randomly sampled from the Department of Human Services enrolment database, which provides near complete coverage of the population
Statistical analysis We identified individuals who had an index hospitalization with a primary diagnosis of MI, stroke or HF who had not used aged care services in the 12 months prior to admission and who survived to hospital discharge
Summary
Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide [1]. It is well known that stroke survivors in the older population are at an increased likelihood of being admitted directly to residential care at the time of hospital discharge [6]. Some studies have suggested that there is an increased likelihood of residential care admission following MI or HF-related hospitalization [7,8,9]. There are critical knowledge gaps regarding health trajectories and transitions between health and aged care services following hospital admission for CVD in older people
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