Association of Alzheimer's Disease and Related Dementias (ADRD) With Days at Home Among Medicare Beneficiaries After a Heart Failure Hospitalization

Abstract

Background: Older adults with concomitant heart failure (HF) and Alzheimer's Disease and Related Dementias (ADRD) are at high risk for adverse outcomes, including health care utilization and mortality. Increasingly, adults with these conditions want to maximize quality of life and days at home (DAH). This study aimed to determine the association between ADRD and DAH following HF hospitalization.

Methods: This retrospective cohort analysis draws from a 20% random sample from 2017 to 2019 Medicare claims of beneficiaries who survived HF hospitalization. The primary outcome was mean DAH 6 months post-hospitalization. Exposure was defined as the presence of diagnosed ADRD, extracted from the Master Beneficiary Summary Base File Chronic Conditions subfile. Multivariable negative binomial regression was used to examine the adjusted association between ADRD and DAH, with covariates selected in accordance with the Andersen model of health care utilization.

Results: The 74,908 Medicare beneficiaries in the cohort had a mean age of 79.1 years (SD 11); half were men (50.0%) and 82.3% were non-Hispanic White. Overall, 18% (n=14,396) had ADRD. Beneficiaries with concomitant ADRD were older, more likely to be female, and more likely to have dual Medicaid/Medicare eligibility compared with those without ADRD. Although DAH in the 6 months preceding admission was similar, following hospitalization those with concomitant ADRD had less time at home (mean DAH 120.7 [65.9] for those with ADRD versus 136.4 [59.7] for those without ADRD). When adjusting for patient characteristics, hospitalization course, and hospital and geographic-level fixed effects, this difference persisted: patients with HF and ADRD spent an estimated 6% fewer DAH post-hospitalization (incidence rate ratio, 0.94 0.93-0.95). In the 6 months post-hospitalization, 10.2% of patients with HF and ADRD spent ≤7 DAH. The odds of spending ≤7 DAH were 24% higher for patients with ADRD (odds ratio, 1.24 [95% CI, 1.16-1.33]).

Conclusions: Following HF hospitalization, Medicare beneficiaries with ADRD spent significantly fewer DAH than those without ADRD. Identifying and addressing the unmet needs of this population after hospitalization is crucial.

Keywords: Alzheimer disease; aging in place; heart failure; odds ratio; patient-centered outcomes research; quality in life; transition of care.