Abstract
Background
Health instability, measured with the Changes in Health and End-Stage Disease Signs and Symptoms (CHESS) scale, predicts hospitalizations and mortality in home-care clients.
Heart failure (HF) is also common among home-care clients. We seek to understand how
HF contributes to the odds of death, hospitalization, or worsening health among new
home-care clients, depending on admission health instability.
Methods
We undertook a retrospective cohort study of home-care clients, aged 65 years and
older, between January 1, 2010, and March 31, 2015 from Alberta, British Columbia,
Ontario, and the Yukon, Canada. We used multistate Markov models to derive adjusted
odds ratios (ORs) for transitions to different health instability states, hospitalization,
and death. We examined the role of HF and CHESS at 6 months after home-care admission.
Results
The sample included 286,232 clients. Those with HF had greater odds of worsening health
instability than those without HF. At low-to-moderate admission health instability
(CHESS 0-2), clients with HF had greater odds of hospitalization and death than those
without HF. Clients with HF and high health instability (CHESS≥3) had slightly greater
odds of hospitalization (OR, 1.08; 95% confidence interval (CI), 1.02-1.13) but similar
odds of death (OR, 1.024; 95% CI, 0.937-1.120) compared with clients without HF.
Conclusions
Among new home-care clients, a diagnosis of HF predicts death, hospitalization, and
worsening health, predominantly among those with low-to-moderate admission health
instability. A diagnosis of HF and admission CHESS score provide complementary information
to support care planning in this population.
Résumé
Contexte
L'instabilité d'un état de santé, mesurée à l'aide de l'échelle CHESS (Changes in Health and End-Stage Disease Signs and Symptoms), permet de prévoir les hospitalisations et la mortalité chez les clients des services
de soins à domicile. L'insuffisance cardiaque (IC) est également fréquente chez les
clients des services de soins à domicile. Nous cherchons à comprendre comment l'IC
contribue aux probabilités de décès, d'hospitalisation ou de détérioration de l'état
de santé des clients des services de soins à domicile, en fonction de l'instabilité
de leur état de santé à l'admission.
Méthodes
Nous avons entrepris une étude de cohorte rétrospective des clients des services de
soins à domicile, âgés de 65 ans et plus, entre le 1er janvier 2010 et le 31 mars 2015, en Alberta, en Colombie-Britannique, en Ontario
et au Yukon, au Canada. Nous avons utilisé des modèles multi-états de type Markovien
pour dériver des rapports des cotes (RC) ajustés pour les transitions vers différents
états d'instabilité de santé, l'hospitalisation et le décès. Nous avons examiné le
rôle de l'IC et du CHESS six mois après l'admission aux services de soins à domicile.
Résultats
L'échantillonnage comprenait 286 232 patients. Ceux qui étaient atteints d'IC avaient
plus de risque de voir leur état de santé s'aggraver que ceux qui ne l'étaient pas.
En cas d'instabilité de l’état de santé de niveau faible à modérée lors de l'admission
(CHESS 0-2), les clients atteints d'IC avaient plus de chances d'être hospitalisés
et de mourir que les autres. Les clients atteints d'IC et présentant une forte instabilité
de leur état de santé (CHESS ≥ 3) avaient un risque légèrement plus élevé d'hospitalisation
(RC, 1,08; intervalle de confiance (IC) à 95 %, 1,02-1,13) mais un risque similaire
de décès (RC, 1,024; IC à 95 %, 0,937-1,120) par rapport aux clients sans IC.
Conclusions
Parmi les nouveaux clients des services de soins à domicile, un diagnostic d'IC prédit
le décès, l'hospitalisation et la détérioration de l'état de santé, principalement
chez ceux dont l'instabilité de l'état de santé à l'admission est faible à modérée.
Un diagnostic d'IC et le score CHESS lors de l'admission fournissent des informations
complémentaires pour aider à la planification des soins de cette population.
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Article info
Publication history
Published online: July 22, 2021
Accepted:
July 16,
2021
Received:
February 7,
2021
Footnotes
See page 1773 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
