Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure

Area of Science:

• Gerontology
• Health Services Research
• Clinical Epidemiology

Background:

• Heart failure is a common condition impacting older adults.
• Nursing home residents represent a vulnerable population with complex health needs.
• Predicting health transitions and adverse outcomes in this population is crucial for effective care.

Purpose of the Study:

• To determine how a heart failure diagnosis and admission health instability predict health transitions and outcomes in newly admitted nursing home residents.
• To assess the combined predictive value of heart failure and health instability on mortality and hospitalizations.
• To identify high-risk patients for targeted interventions within nursing homes.

Main Methods:

• Retrospective cohort study utilizing linked administrative data from Canadian nursing homes, hospitals, and emergency departments (2010-2016).
• Inclusion of 143,067 older adults (≥65 years).
• Multistate Markov models used to estimate odds ratios for transitions between health states, stratified by heart failure diagnosis and interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) scores.

Main Results:

• A heart failure diagnosis was associated with increased health instability, hospitalizations, and mortality.
• The impact of heart failure on hospitalizations and death was most pronounced in residents with low baseline health instability (CHESS=0).
• Residents with the highest health instability were more likely to die in hospital.

Conclusions:

• Heart failure diagnosis and health instability are complementary predictors of adverse outcomes in nursing home residents.
• Early identification of high-risk patients with heart failure and significant health instability can inform targeted interventions.
• These findings support proactive management strategies to improve care quality and reduce adverse events in nursing homes.