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Multicenter Study
. 2016 Jun;22(6):792-8.
doi: 10.1093/icvts/ivw045. Epub 2016 Mar 10.

Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study

Kristinn Thorsteinsson  1 , Jan J Andreasen  2 , Rikke N Mortensen  3 , Kristian Kragholm  4 , Christian Torp-Pedersen  5 , Gunnar Gislason  6 , Lars Køber  7 , Kirsten Fonager  8
Affiliations
Multicenter Study

Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study

Kristinn Thorsteinsson et al. Interact Cardiovasc Thorac Surg. 2016 Jun.

Abstract

Objectives: Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort.

Methods: All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012.

Results: A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively.

Conclusions: The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.

Keywords: Coronary artery bypass grafting; Home care; Mortality; Nursing home; Octogenarians; Survival.

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Figures

Figure 1:
Figure 1:
Survival. One-year follow-up.
Figure 2:
Figure 2:
Cumulative incidence of nursing home admission; 1-year follow-up.
Figure 3:
Figure 3:
Cumulative incidence of nursing home admission; 17-year follow-up.
Figure 4:
Figure 4:
Patient journey, showing day by day changes for patient ≥80 years of age; 1-year follow-up.
Figure 5:
Figure 5:
Patient journey, showing day by day changes for patient ≥80 years of age; 5-year follow-up.
Figure 6:
Figure 6:
Cumulative incidence of home care usage after isolated CABG. CABG: coronary artery bypass grafting.
See this image and copyright information in PMC

References

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