Resumen de Nursing Home Use After Implantable Cardioverter-Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry
Daniel B. Kramer, Matthew R. Reynolds, Sharon-Lise Normand, Craig S. Parzynski, John A. Spertus, Vincent Mor, Susan L. Mitchell
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 ICDs between January 1, 2006, and March 31, 2010 (N = 192,483).
Measurements Proportion of ICD recipients discharged to NHs 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 NHs 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.
