https://doi.org/10.4081/monaldi.2022.2125
Cardiovascular disease patients and predictors of length of stay of residential of cardiac rehabilitation. A specific rehabilitation is mandatory in very old patients?
Submitted: October 15, 2021
Accepted: March 29, 2022
Published: April 7, 2022
Accepted: March 29, 2022
Abstract Views: 1499
PDF: 373
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
As more adults are living into old age, they are predisposed to cardiovascular disease (CVD) and the demand for cardiac rehabilitation is increasing. We aimed to verify predictors of length of stay (LOS) in young (Y) vs older (O) vs very old (VO) CVD patients, admitted to residential cardiac rehabilitation. Patients’ demographic and clinical characteristics at admission, as well as Barthel index (BI), Cumulative Illness Rating Scale (CIRS), comorbidity severity/complexity, NYHA classification, left ventricular ejection fraction (LVEF), physical activity level were compared in Y (≤65 years) vs O (between >65 and <76 years) vs VO patients (with an age of ≥76 years) against LOS. In 5,070 consecutively CVD patients were included; they were 1392 Y (38%) 1944 O (35%) 1334 VO patients (27%) and LOS duration was 16±7, 19±9 and 22±10 days, respectively (p<0.0001). In Y, LOS was linked to BI (p=0.000) and to LVEF (p=0.000) at multivariable analysis with area under ROC curve of 0.82, whereas in O, LOS was associated to gender (p=0.013) CIRS severity (p=0.000), BI (p=0.000), LVEF (p=0.000), and in those VO to gender (p=0.004), BI (p=0.000) and medical infusion (p=0.000) at multivariable with ROC curve of 0.83 and 0.74, respectively. In very old patients, a prolonged LOS is related to extra-cardiac conditions. Therefore, we promote a specific cardiac rehabilitation for these patients.
Bloom BS. Crossing the quality chasm: a new health system for the 21st century. JAMA 2002;287:646 –7.
DOI: https://doi.org/10.1001/jama.287.5.646-a
Gonzalez JM. National Health Care Expenses in the U.S. Civilian Noninstitutionalized Population, 2011. MEPS Statistical Brief #425. Agency for Healthcare Research and Quality: Rockville; 2013. Accessed march the 1st, 2021. Available from: www.meps.ahrq.gov/data_files/publications/st425/stat425.pdf
Lu M, Sajobi T, Lucy K, et al. Systematic review of risk adjustment models of hospital length of stay (LOS). Med Care 2015;53:355–65.
DOI: https://doi.org/10.1097/MLR.0000000000000317
Carey M, Sheth H, Braithwaite R. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med 2005;20:108–15.
DOI: https://doi.org/10.1111/j.1525-1497.2005.40269.x
Geissler A, Scheller-Kreinsen D, Quentin W. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries. Health Econ 2012;21:103–15.
DOI: https://doi.org/10.1002/hec.2848
Ghali WA, Hall RE, Ash AS, et al. Identifying pre- and postoperative predictors of cost and length of stay for coronary artery bypass surgery. Am J Med Qual 1999;14:248–54.
DOI: https://doi.org/10.1177/106286069901400604
Every NR, Spertus J, Fihn SD, et al. Length of hospital stay after acute myocardial infarction in the myocardial infarction triage and intervention (MITI) project registry. J Am Coll Cardiol 1996;28:287–93.
DOI: https://doi.org/10.1016/0735-1097(96)00168-4
Iezzoni LI, Shwartz M, Ash AS, et al. Does severity explain difference in hospital length of stay for pneumonia patients? Health Serv Res 1996;1:65–76.
DOI: https://doi.org/10.1177/135581969600100204
Matsui K, Goldman L, Johnson PA, et al. Comorbidity as a correlate of length of stay for hospitalized patients with acute chest pain. J Gen Intern Med 1996;11:262–8.
DOI: https://doi.org/10.1007/BF02598265
Kanazawa N, Iijima H, Fushimi K. In-hospital cardiac rehabilitation and clinical outcomes in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective cohort study. BMJ Open 2020;10:e039096.
DOI: https://doi.org/10.1136/bmjopen-2020-039096
Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021;28:460-95.
DOI: https://doi.org/10.1177/2047487320913379
Boccanelli A, Cao PG, Chiariello L, et al. [Criteri di appropriatezza clinica, tecnologica e strutturale nell’assistenza alle malattie del sistema cardiovascolare].[Report in Italian] Quaderni del Ministero della Salute 2010;1;133. Available from: https://www.salute.gov.it/imgs/C_17_pubblicazioni_1697_allegato.pdf
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965;14:61-5.
DOI: https://doi.org/10.1037/t02366-000
Marcassa C, Giordano A, Corrà U, Giannuzzi P. Greater functional improvement in patients with diabetes after rehabilitation following cardiac surgery. Diabet Med 2016;33:1067-75.
DOI: https://doi.org/10.1111/dme.12882
de Groot V, Beckerman H, Lankhorst GJ, Boute LM. How to measure comorbidity: a critical review of available methods. J Clinical Epidem 2003;56:221-9.
DOI: https://doi.org/10.1016/S0895-4356(02)00585-1
Hosmer DW, Lemeshow S. Assessing the fit of model. In: DW Hosmer, S Lemeshow, Editors. Applied Logistic Regression, 2nd Ed. J. Wiley & Sons: New York; 2000. p. 143-202.
DOI: https://doi.org/10.1002/0471722146
Vigorito C, Abreu A, Ambrosetti M, et al. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol 2017;24:577-90.
DOI: https://doi.org/10.1177/2047487316682579
Cacciatore F, Abete P, Mazzella F, et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest 2005;35:723-30.
DOI: https://doi.org/10.1111/j.1365-2362.2005.01572.x
Hoenig H, Nusbaum N, Brummel-Smith K. Geriatric rehabilitation: state of the art. J Am Geriatr Soc 1997;45:1371-81.
DOI: https://doi.org/10.1111/j.1532-5415.1997.tb02939.x
Henry SB, Holzemer WL. Achievement of appropriate self-care: does care delivery system make a difference? Med Care 1997;35:NS33-40.
DOI: https://doi.org/10.1097/00005650-199711001-00004
Listerman J, Bittner V, Sanderson BK, Brown TM. Cardiac rehabilitation outcomes: Impact of comorbidities and age. J Cardiopulm Rehabil Prev 2011;31:342-8.
DOI: https://doi.org/10.1097/HCR.0b013e31822f189c
Perrenoud JJ. Cardiac Rehabilitation. Eur Geriatric Med 2011:2;296-8.
DOI: https://doi.org/10.1016/j.eurger.2011.04.005
Schopfer DW Forman DE. Cardiac rehabilitation in older adults. Can J Cardiol 2016;32:1088-96.
DOI: https://doi.org/10.1016/j.cjca.2016.03.003
Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL; a standardized measure of biological and psycological functions. JAMA 1963;185:914-9.
DOI: https://doi.org/10.1001/jama.1963.03060120024016
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.
DOI: https://doi.org/10.1016/0022-3956(82)90033-4
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-96.
DOI: https://doi.org/10.1016/0022-3956(75)90026-6
Bittner V. Six-minute walk test in patients with cardiac dysfunction. Cardiology 1997;42:897-902.
Tinetti ME. Performance-oriented mobility assessment of problems in elderly patients. J Am Geriatr Soc 1986;34:119-26.
DOI: https://doi.org/10.1111/j.1532-5415.1986.tb05480.x
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994 49:M85-94.
DOI: https://doi.org/10.1093/geronj/49.2.M85
Bell SP, Saraf AA. Epidemiology of multimorbidity in older adults with cardiovascular disease. Clin Geriatr Med 2016;32:215-26.
DOI: https://doi.org/10.1016/j.cger.2016.01.013
Frederix I, Caiani E, Dendale P, et al. ESC e-Cardiology Working Group Position Paper: Overcoming challenges in digital health implementation in cardiovascular medicine. Eur J Prev Cardiol 2019;26:1166-77.
DOI: https://doi.org/10.1177/2047487319832394
Saner H. Digital health implementation: How to overcome the barriers? Eur J Prev Cardiol 2019;26:1164–5.
DOI: https://doi.org/10.1177/2047487319848222
Nabutovsky I, Nachshon A, Klempfner R, et al. Digital cardiac rehabilitation programs: the future of patient-centered medicine. Telemed J E Health 2020;26:34-41.
DOI: https://doi.org/10.1089/tmj.2018.0302
Griffo R, Tramarin R, Volterrani M, et al. [The Italian Survey on Cardiac Rehabilitation (ISYDE.13-Directory): report su strutture, organizzazione e programmi di cardiologia riabilitativa in Italia].[Article in Italian]. G Ital Cardiol (Rome) 2016;17:217-24.
How to Cite
Corrà, Ugo, Andrea Giordano, Marco Gnemmi, Fabiana Isabella Gambarin, Claudio Marcassa, and Massimo Pistono. 2022. “Cardiovascular Disease Patients and Predictors of Length of Stay of Residential of Cardiac Rehabilitation. A Specific Rehabilitation Is Mandatory in Very Old Patients?”. Monaldi Archives for Chest Disease 92 (4). https://doi.org/10.4081/monaldi.2022.2125.
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