Days Not at Home: Association of Vulnerability with Healthcare Utilization After Hospitalization for Heart Failure

BACKGROUND: Heart failure (HF) hospitalizations are characterized by vulnerability in functioning and frequent post-discharge healthcare utilization in both acute and post-acute settings. OBJECTIVE: To determine, in patients hospitalized for decompensated HF, the association of vulnerability with (1) detailed forms of post-discharge healthcare utilization, and (2) days spent away from home after initial hospital discharge. DESIGN: Secondary analysis of a prospective longitudinal cohort study from a single-center academic institution in the USA. PARTICIPANTS: Adults admitted with acute decompensated HF who were discharged alive. MAIN MEASURES: The Vulnerable Elders Survey 13 (VES-13) measured functional vulnerability at baseline. The primary outcome was the Highest Healthcare Utilization (HHU) 90 days post-discharge, from the following ordered categories: at home, emergency room visit, skilled nursing facility stay, hospital readmission, or death. The secondary outcome was the proportion of days not at home (DNAH) within the first 90 days. Analyses were performed using a partial proportional odds model with adjustment for demographics and health characteristics. KEY RESULTS: A total of 806 patients were included with median age 65, interquartile range [IQR] 55-73 years. Fewer than half (N = 345 [43%]) of patients remained alive and at home during 90-day follow-up. There were 286 [35%] hospital readmissions and 70 [8.7%] participants died. The median DNAH was 3 [IQR 0-16]. Increased vulnerability was associated with (1) HHU, (2) higher odds of utilizing healthcare or dying versus being at home alive 90 days post-discharge (OR 1.81 [95% CI, 1.35, 2.42]), and (3) higher odds of DNAH in the first 90 days (OR 1.55 [95% CI, 1.27, 1.89]). CONCLUSIONS: In this cohort of patients hospitalized for decompensated HF, vulnerability predicted higher levels of healthcare utilization, as well as total days not at home in the 90 days following hospitalization. Vulnerability may have clinical applications to identify patients at greatest need for comprehensive, patient-centered discharge planning.