Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis
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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.
