Association of orthogeriatric services with long-term mortality in patients with hip fracture.

PURPOSE: To assess the impact of the comprehensive orthogeriatric care model (OGM) on 2-year survival, length of stay (LOS), discharges to nursing homes, and antiosteoporotic treatment (AOT) in patients with hip fracture. METHODS: Retrospective cohort study. Hospitals were classified as OGM if the patient was cared for in a comprehensive orthogeriatric unit. We included data from patients ≥ 65 years old discharged between 2012 and 2013. The main outcome was 12- and 24-month mortality. The variables collected were sex, type of fracture, comorbidities, AOT, LOS, and discharge to nursing homes. Survival analysis was performed with Kaplan-Meier method and comparison with Mantel-Haenszel test. Factors associated with death were determined by logistic regression. RESULTS: First admissions in the 12 (out of 32) hospitals with OGM were 3580 of 9215 (38.8%). Patients in OGM had more comorbidities and discharges to nursing homes, shorter LOS, and less prescription of AOT. Two years after the admission the deceased patients were 3000 (32.6%). The survival was lower in males (p < 0.001), in the older age groups (p < 0.001), and in patients with Charlson > 1 (p < 0.001). Factors associated with increased risk of death at 12 and 24 months (logistic regression) were male gender, age and Charlson > 1, while care in the OGM decreased the risk. OGM benefited more patients > 80 years and those with Charlson < 1. CONCLUSIONS: Patients admitted in OGM have shorter stays, more discharges to nursing homes, lower prescription of AOT, and better 12- and 24-month survival adjusted by sex, age, and comorbidities compared to non-OGM care.

Determinants of survival and hospitalization in older, heart failure patients receiving home healthcare.

INTRODUCTION: Since reported evidence is both scarce and controversial, the objective of this study is to determine the risk factors involved in the prognosis of older patients with heart failure (HF) receiving home healthcare from primary care professionals. METHODS: Retrospective cohort community study was carried out in 52 primary healthcare centers in Barcelona (Spain). A follow-up was performed between January 2009 and December 2012 with 7461 HF patients aged >64years. Information was obtained from primary care electronic medical records containing clinical data, functional and cognitive status, total mortality, and hospital admissions for cardiovascular events. RESULTS: Mortality and hospitalization during follow-up were higher in older, HF patients who received home healthcare than those who did not (HR 1.39, 95% CI 1.22-1.58 and 1.92 95% CI 1.72-2.14, respectively). The most relevant determinants for mortality were male gender (HR 1.40, 95%CI 1.10-1.79), previous hospital admission for HF (HR 1.29 95%CI 1.05-1.60), and severe dependence in activities for daily living (ADL) (HR 1.33, 95%CI 1.06-1.67). In contrast, severely dependent ADL patients were not more frequently hospitalized as a consequence of cardiovascular events (0.97, 95% CI 0.77-1.23). CONCLUSIONS: Due to their greater comorbidity and age, mortality and hospitalization in patients requiring home healthcare were higher than those who did not. Among the HF patients receiving home care, mortality and hospital admissions were higher in men, older patients, and in those previously hospitalized for HF. Severe dependence in ADL determined a higher mortality but was not related to increased hospital admission rates.

Tendencias y variables predictoras de hospitalización, reingreso y duración de la estancia hospitalaria en los pacientes ambulatorios con insuficiencia cardíaca / Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure

Objetivos. En los pacientes ambulatorios con insuficiencia cardiaca crónica apenas se conocen las variables pronósticas de hospitalización, y es posible que las variables conocidas no sean aplicables a la población de los países mediterráneos. El objetivo del presente estudio es documentar las tendencias longitudinales en las hospitalizaciones e identificar las variables predictoras de ingreso, reingreso y duración de la estancia hospitalaria en la población objeto del estudio. Métodos. Estudio de cohorte retrospectivo, poblacional, efectuado en Cataluña (noreste de España). Se incluyeron a 7.196 pacientes ambulatorios (58,6% mujeres, edad media: 76 años). Se seleccionaron los pacientes elegibles a partir de la historia clínica electrónica de los centros de atención primaria y se les controló durante 3 años. Resultados. A los 3 años del seguimiento, en conjunto, 645 (9,0%) pacientes fueron ingresados por una causa cardiovascular, el 37% presentó un reingreso, y la duración mediana de la estancia hospitalaria fue de 9 (límites intercuartil:5-17) días. La insuficiencia renal crónica (odds ratio [OR]:1,98 [1,62-2,43]), la cardiopatía isquémica (OR:1,72; intervalo de confianza [IC] del 95%:1,45-2,04), la diabetes mellitus (DM) (OR:1,50; IC 95%:1,27-1,78) y la enfermedad pulmonar obstructiva crónica (OR:1,43; IC 95%:1,16-1,77) aumentaron el riesgo de hospitalización. La DM (OR:1,70; IC 95%:1,22-2,38), la cardiopatía isquémica (OR:1,85; IC 95%:1,33-2,58) y la hipertensión arterial (OR:1,66; IC 95%:1,11-2,46) aumentaron el riesgo de reingreso. La insuficiencia renal crónica (OR:2,21; IC 95%:1,70-2,90), la cardiopatía isquémica (OR:2,19; IC 95%:1,73-2,77), la DM (OR:1,70; IC 95%:1,34-2,15), la hipertensión arterial (OR:1,51; IC 95%:1,13-2,01) y la enfermedad pulmonar obstructiva crónica (OR:1,37; IC 95%:1,02-1,83) aumentaron el riesgo de duración prolongada de la estancia hospitalaria. Conclusiones. El presente estudio identificó las variables predictoras de hospitalización, los reingresos y la duración prolongada de la estancia hospitalaria que pueden ayudar a los médicos y gestores hospitalarios a identificar a los pacientes en alto riesgo, que deben ser los destinatarios de la planificación de los servicios y de las acciones preventivas establecidas(AU)

Objectives. Little is known on predictors of hospitalisation in ambulatory patients with chronic heart failure, and known predictors may not apply to Mediterranean countries. Our aim was to document longitudinal trends in hospitalisations and identify patient-related predictors of hospital admission, re-admission and length of stay in the targeted population. Methods. Population-based retrospective cohort study in Catalonia (North-East Spain), including 7196 ambulatory patients (58.6% women; mean age 76 years). Eligible patients were selected from the electronic patient records of primary care practices, and followed for 3 years. Results. At 3 years of follow up overall 645 (9.0%) patients had cardiovascular hospitalisation, 37% were readmitted, and median length of stay was 9 (interquartile range 5–17) days. Chronic kidney disease [odds ratio (OR)=1.98 (1.62–2.43)], IHD [OR=1.72 (1.45–2.04)], DM [OR=1.50 (1.27–1.78)] and chronic obstructive pulmonary disease [OR=1.43 (1.16–1.77)] increased the risk for hospitalisation. DM [OR=1.70 (1.22–2.38)], IHD [OR=1.85 (1.33–2.58)] and HTA [OR=1.66 (1.11–2.46)] increased the risk for readmissions. Chronic kidney disease [OR of 2.21 (1.70–2.90)], IHD [OR of 2.19 (1.73–2.77)], DM [OR=1.70 (1.34–2.15)], HTA [OR=1.51 (1.13–2.01)], chronic obstructive pulmonary disease [OR=1.37 (1.02–1.83)] increased the risk for long length of stay in hospital. Conclusions. Our study identified predictors of hospitalisation, readmissions and long length of stay which can help clinicians and managers to identify high risk patients which should be targeted on service planning and when designing preventive actions(AU)

Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure.

OBJECTIVES: Little is known on predictors of hospitalisation in ambulatory patients with chronic heart failure, and known predictors may not apply to Mediterranean countries. Our aim was to document longitudinal trends in hospitalisations and identify patient-related predictors of hospital admission, re-admission and length of stay in the targeted population. METHODS: Population-based retrospective cohort study in Catalonia (North-East Spain), including 7196 ambulatory patients (58.6% women; mean age 76 years). Eligible patients were selected from the electronic patient records of primary care practices, and followed for 3 years. RESULTS: At 3 years of follow up overall 645 (9.0%) patients had cardiovascular hospitalisation, 37% were readmitted, and median length of stay was 9 (interquartile range 5-17) days. Chronic kidney disease [odds ratio (OR)=1.98 (1.62-2.43)], IHD [OR=1.72 (1.45-2.04)], DM [OR=1.50 (1.27-1.78)] and chronic obstructive pulmonary disease [OR=1.43 (1.16-1.77)] increased the risk for hospitalisation. DM [OR=1.70 (1.22-2.38)], IHD [OR=1.85 (1.33-2.58)] and HTA [OR=1.66 (1.11-2.46)] increased the risk for readmissions. Chronic kidney disease [OR of 2.21 (1.70-2.90)], IHD [OR of 2.19 (1.73-2.77)], DM [OR=1.70 (1.34-2.15)], HTA [OR=1.51 (1.13-2.01)], chronic obstructive pulmonary disease [OR=1.37 (1.02-1.83)] increased the risk for long length of stay in hospital. CONCLUSIONS: Our study identified predictors of hospitalisation, readmissions and long length of stay which can help clinicians and managers to identify high risk patients which should be targeted on service planning and when designing preventive actions.