Key result
Delirium without dementia links to ~120% higher 30-day mortality in HF patients discharged to SNFs.
Why the study?
Heart failure outcomes are disproportionately worse in patients discharged to skilled nursing facilities versus home, but the roles of dementia and delirium were unclear.
Does the presence of delirium increase the risk of hospital readmission and mortality in heart failure patients discharged to skilled nursing facilities?
Cohort (n=21,655)
Yes
Does the presence of delirium increase the risk of hospital readmission and mortality in heart failure patients discharged to skilled nursing facilities?
Effect estimate: HR 2.2 (95% CI 1.7-3.0)
Absolute Event Rate: 12.24% vs 5.57%
Delirium is an independent risk factor for increased short- and long-term mortality in heart failure patients discharged to skilled nursing facilities, highlighting the critical need for cognitive screening during care transitions.
Supports delirium screening at SNF discharge in HF; extends observational data but leaves open intervention effects.
AIM: Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. METHODS AND RESULTS: The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre-existing dementia was identified based on International Classification of Diseases-9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (-) of dementia and delirium. Relative to the dementia-/delirium- group, the dementia-/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia-/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium-/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. CONCLUSIONS: Delirium, independent of pre-existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs.
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Lafo et al. (2022) conducted a cohort in Heart failure (n=21,655). Delirium without dementia vs. No delirium and no dementia was evaluated on 30-day mortality (HR 2.2, 95% CI 1.7-3.0). Delirium without pre-existing dementia significantly increased the risk of 30-day mortality (HR 2.2) compared to patients with neither condition among heart failure patients discharged to skilled nursing facilities.
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