Evidence map›Paper›PMID 39331226›Full record

ArticleJournal of general internal medicine2025

Days Not at Home: Association of Vulnerability with Healthcare Utilization After Hospitalization for Heart Failure.

Sarah A Welch, Chiara Di Gravio, Jonathan S Schildcrout, Ricardo Trochez, Yaping Shi, Devika Nair, Eduard E Vasilevskis, Amanda S Mixon, Susan P Bell, Sunil Kripalani

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sarah A WelchDepartment of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA. sarah.welch@vumc.org.ORCID 0000-0002-1309-4531
Chiara Di GravioDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Jonathan S SchildcroutDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Ricardo TrochezDivision of General Internal Medicine and Public Health, Department of Medicine, Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Yaping ShiDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Devika NairDivision of Nephrology Medicine, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt O'Brien Center for Kidney Disease, Nashville, TN, USA.
Eduard E VasilevskisDivision of Hospital Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Amanda S MixonGeriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
Susan P BellDivision of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Sunil KripalaniDivision of General Internal Medicine and Public Health, Department of Medicine, Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.

Funding

Health Literacy, Hospital Discharge, and Cardiovascular OutcomesR01HL109388 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI KRIPALANI, SUNIL · 2011 to 2015
$3.3M
NHLBI Division of Intramural Research R01HL109388NHLBI NIH HHS R01 HL109388NIDDK NIH HHS K23DK1297742
6 · The paper itself

Abstract

backgroundHeart failure (HF) hospitalizations are characterized by vulnerability in functioning and frequent post-discharge healthcare utilization in both acute and post-acute settings.

objectiveTo determine, in patients hospitalized for decompensated HF, the association of vulnerability with (1) detailed forms of post-discharge healthcare utilization, and (2) days spent away from home after initial hospital discharge.

designSecondary analysis of a prospective longitudinal cohort study from a single-center academic institution in the USA.

participantsAdults admitted with acute decompensated HF who were discharged alive. MAIN MEASURES: The Vulnerable Elders Survey 13 (VES-13) measured functional vulnerability at baseline. The primary outcome was the Highest Healthcare Utilization (HHU) 90 days post-discharge, from the following ordered categories: at home, emergency room visit, skilled nursing facility stay, hospital readmission, or death. The secondary outcome was the proportion of days not at home (DNAH) within the first 90 days. Analyses were performed using a partial proportional odds model with adjustment for demographics and health characteristics. KEY

resultsA total of 806 patients were included with median age 65, interquartile range [IQR] 55-73 years. Fewer than half (N = 345 [43%]) of patients remained alive and at home during 90-day follow-up. There were 286 [35%] hospital readmissions and 70 [8.7%] participants died. The median DNAH was 3 [IQR 0-16]. Increased vulnerability was associated with (1) HHU, (2) higher odds of utilizing healthcare or dying versus being at home alive 90 days post-discharge (OR 1.81 [95% CI, 1.35, 2.42]), and (3) higher odds of DNAH in the first 90 days (OR 1.55 [95% CI, 1.27, 1.89]).

conclusionsIn this cohort of patients hospitalized for decompensated HF, vulnerability predicted higher levels of healthcare utilization, as well as total days not at home in the 90 days following hospitalization. Vulnerability may have clinical applications to identify patients at greatest need for comprehensive, patient-centered discharge planning.

Indexed as

Heart FailureHospitalizationPatient Acceptance of Health CarePatient DischargeVulnerable PopulationsAgedAged, 80 and overCohort StudiesFemaleHumansLongitudinal StudiesMaleMiddle AgedProspective Studieshealthcare utilizationheart failurehospitalizationvulnerability

Identifiers

PMID39331226
PMCPMC11861822

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.