Delirium and Functional Recovery in Patients Discharged to Skilled Nursing Facilities After Hospitalization for Heart Failure

Key Points Question Is delirium associated with 30-day functional recovery in patients discharged to skilled nursing facilities after heart failure hospitalization? Findings In this cohort study of 20 495 patients from the US Department of Veterans Affairs health system discharged to skilled nursing facilities after heart failure hospitalization, delirium was associated with poor functional recovery. The baseline Activities of Daily Living score on admission to a skilled nursing facility was significantly worse among patients with delirium; patients with delirium also had significantly lower Activities of Daily Living improvement from baseline to follow-up assessments. Meaning Study results suggest that delirium on admission to skilled nursing facilities after heart failure hospitalization was associated with poor functional recovery.

[1]  S. Richter,et al.  Assessment of the Accuracy of Using ICD-9 Diagnosis Codes to Identify Pneumonia Etiology in Patients Hospitalized With Pneumonia , 2020, JAMA network open.

[2]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association , 2020, Circulation.

[3]  Stephen M. Thielke,et al.  Detection of probable dementia cases in undiagnosed patients using structured and unstructured electronic health records , 2019, BMC Medical Informatics and Decision Making.

[4]  T. Libermann,et al.  Delirium and Alzheimer disease: A proposed model for shared pathophysiology , 2019, International journal of geriatric psychiatry.

[5]  R. Nohara,et al.  A decline in activities of daily living due to acute heart failure is an independent risk factor of hospitalization for heart failure and mortality. , 2019, Journal of cardiology.

[6]  R. Schürch,et al.  A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study , 2018, BMC Health Services Research.

[7]  S. Apold.  Delirium Superimposed on Dementia , 2018 .

[8]  G. Gobbel,et al.  Automating Quality Measures for Heart Failure Using Natural Language Processing: A Descriptive Study in the Department of Veterans Affairs , 2018, JMIR medical informatics.

[9]  V. Mor,et al.  Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes , 2017, Journal of the American Geriatrics Society.

[10]  T. Travison,et al.  Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery , 2017, Annals of surgery.

[11]  Mary A. Dolansky,et al.  Skilled Nursing Facility Care for Patients With Heart Failure: Can We Make It "Heart Failure Ready?" , 2016, Journal of cardiac failure.

[12]  K. Davis,et al.  ICD-9 diagnosis codes have poor sensitivity for identification of preexisting comorbidities in traumatic fracture patients: A study of the National Trauma Data Bank , 2015, The journal of trauma and acute care surgery.

[13]  S. Inouye,et al.  The interface between delirium and dementia in elderly adults , 2015, The Lancet Neurology.

[14]  V. Roger,et al.  Activities of Daily Living and Outcomes in Heart Failure , 2015, Circulation. Heart failure.

[15]  J. McMurray,et al.  ‘Hearts and minds’: association, causation and implication of cognitive impairment in heart failure , 2015, Alzheimer's Research & Therapy.

[16]  J. Saczynski,et al.  Delirium in elderly people , 2014, The Lancet.

[17]  Daniël Lakens,et al.  Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs , 2013, Front. Psychol..

[18]  Y. Gustafson,et al.  Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions. , 2013, Archives of gerontology and geriatrics.

[19]  F. Abelha,et al.  Congestive heart failure as a determinant of postoperative delirium. , 2013, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[20]  N. Raz,et al.  Obesity Interacts with Cerebral Hypoperfusion to Exacerbate Cognitive Impairment in Older Adults with Heart Failure , 2012, Cerebrovascular Diseases Extra.

[21]  D. Berlowitz,et al.  Overview of significant changes in the Minimum Data Set for nursing homes version 3.0. , 2012, Journal of the American Medical Directors Association.

[22]  Russell R. Miller,et al.  The relationship between delirium duration, white matter integrity, and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging: The VISIONS prospective cohort magnetic resonance imaging study* , 2012, Critical care medicine.

[23]  G. Gurm,et al.  Usefulness of acute delirium as a predictor of adverse outcomes in patients >65 years of age with acute decompensated heart failure. , 2011, The American journal of cardiology.

[24]  E. Marcantonio.  Delirium , 2011, Annals of Internal Medicine.

[25]  Adrian F Hernandez,et al.  Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure , 2011, Circulation. Heart failure.

[26]  E. Marcantonio,et al.  Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery , 2010, Journal of the American Geriatrics Society.

[27]  Frederik Barkhof,et al.  Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort , 2009, BMJ : British Medical Journal.

[28]  L. Lipsitz,et al.  Derivation and Validation of a Preoperative Prediction Rule for Delirium After Cardiac Surgery , 2009, Circulation.

[29]  Stephen V Faraone,et al.  Interpreting estimates of treatment effects: implications for managed care. , 2008, P & T : a peer-reviewed journal for formulary management.

[30]  S. Inouye,et al.  The Confusion Assessment Method: A Systematic Review of Current Usage , 2008, Journal of the American Geriatrics Society.

[31]  Matthias Egger,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies , 2007, PLoS medicine.

[32]  Frank Lawrence,et al.  Recognizing Delirium Superimposed on Dementia , 2008 .

[33]  M. Dellefield,et al.  Interdisciplinary care planning and the written care plan in nursing homes: a critical review. , 2006, The Gerontologist.

[34]  E. Marcantonio,et al.  Outcomes of Older People Admitted to Postacute Facilities with Delirium , 2005, Journal of the American Geriatrics Society.

[35]  S K Inouye,et al.  Clarifying confusion: the confusion assessment method. A new method for detection of delirium. , 1990, Annals of internal medicine.

[36]  Biykem Bozkurt,et al.  2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. , 2013, Circulation.