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Geriatric co-management for cardiology patients in the hospital: A quasi-experimental study

Journal Contribution - Journal Article

Background/Objectives: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. Design: A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at six months. Setting: Two cardiac care units of the University Hospitals Leuven. Participants: 151 intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation Intervention: A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 hours of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. Measurements: The primary outcome was functional status measured using the Katz Index for independence in Activities of Daily Living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. Results: The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p=0.019), and experienced 18% less functional decline during hospitalization (25% versus 43%, p=0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-months follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. Conclusions: This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes.
Journal: Journal of the American Geriatrics Society
ISSN: 0002-8614
Issue: 5
Volume: 69
Pages: 1 - 11
Publication year:2021
BOF-keylabel:yes
IOF-keylabel:yes
BOF-publication weight:6
CSS-citation score:3
Authors from:Government, Higher Education
Accessibility:Open