Nursing Home Use After Implantable Cardioverter‐Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry. Issue 2 (7th November 2016) - Kramer, Daniel B.
Abstract : 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.