Abstract
Heart failure (HF) is associated with frequent rehospitalisations because of exacerbation of symptoms. Integrated and comprehensive health care models, such as case management, are used to improve patient outcomes and decrease health care utilisation. Case management can reduce, however, not completely eliminate the risk for rehospitalisation and admission in long-term facilities. The purpose of this study was to examine the rehospitalisation and institutionalisation rate of elderly HF patients vs. non-HF elderly both receiving geriatric case management. Furthermore, it was explored whether HF was an independent determinant of rehospitalisation and institutionalisation. As part of a large Belgian case management project, 866 (67% females) elderly, discharged with a primary or secondary diagnosis of HF, and 3349 (69% females) non-HF elderly were included in this descriptive, multicentre study. Mean age was 82.7 (S.D. = 7.4) and 80.6 (S.D. = 7.9) years, respectively. Demographic, clinical, functional, cognitive and emotional variables, as well as caregiver burden, were collected during interview with the patient and significant others, or were obtained from medical patient records. Multiple logistic regression (enter-method) was used to identify the impact of HF on rehospitalisation and institutionalisation, adjusting for other influencing factors. At discharge, significantly more HF patients (28.1%) were referred to a nursing home, compared to non-HF patients (23.4%) (χ2 = 8.062; P = 0.045). From the HF patients that were discharged to their home or a convalescent home, 9.3% and 25.8% were readmitted within 14 and 90 days after discharge, respectively. This is significantly (P < 0.003) higher than the rehospitalisation rate of 5.4% (14 days) and 20.4% (90 days) in non-HF patients. Multiple logistic regression revealed that, adjusted for available demographic, clinical, functional, cognitive, emotional and caregiver-related factors, HF was an independent determinant for institutionalisation (OR = 2.13; 95% CI = 1.43–3.17) and rehospitalisation within the 90 days after discharge (OR = 1.53; 95% CI = 1.01–2.30). Conclusion: This study indicated that HF is an independent risk factor for rehospitalisation and institutionalisation in the elderly. This may suggest that elderly HF patients are in need for case management models specifically focused on HF, rather than case management for geriatric patients in general. Comprehensive health care programmes and optimal use of treatment modalities are crucial to diminish health care utilisation in this frail population.