Development of a multivariable model to predict vulnerability in older American patients hospitalised with cardiovascular disease

Abstract

Objectives: To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool.

Participants: Prospective observational cohort study of 445 individuals aged ≥ 65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure.

Methods: Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease.

Results: Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002).

Conclusions: Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services.

Keywords: GERIATRIC MEDICINE.

Figure 1

(A) Primary Multivariable Proportional Odds Model for VES-13 score demonstrating linear associations per unit increase of VES-13 score; (B) non-linear relationship of increasing depressive symptoms (PHQ-8) score with odds of increased VES-13 score; (C) estimated intercepts from the proportional odds model that capture the odds of being at or above each VES score when continuous variables are centred at their median and discrete variables are set to their reference level (Note: for number of hospital and ER visits, values were centred at zero visits). ACS, acute coronary syndrome; ER, emergency room; MIDUS, Midlife Development in the United States; PHQ, Patient Health Questionnaire; s-TOFHLA, short form of the Test of Functional Health Literacy in Adults; VES, Vulnerable Elders Survey.