Jane Andreasen1,2, Robbert J J Gobbens3,4,5, Helle Højmark Eriksen6, Kim Overvad7,8. 1. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. jaan@rn.dk. 2. Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg, Denmark. jaan@rn.dk. 3. Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands. 4. Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, The Netherlands. 5. Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. 6. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. 7. Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. 8. Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark.
Abstract
PURPOSE: To assess whether health-related quality of life (HRQOL) status, using the European Quality of life-5 dimensions (EQ5D), in acutely admitted older medical patients was associated with a combined end-point including first unplanned readmission or death without prior readmission within 6 months. Secondly, to assess if HRQOL was associated with death regardless of previous readmissions. METHODS: Patients from seven medical and two acute medical units were included and the EQ5D was obtained at discharge. Associations were assessed using Cox regression. Harrell's C-statistics indicated the predictive performance. RESULTS: 1328 patients were included, 50% (n = 664) were readmitted (n = 635) or had died without prior readmission (n = 29) within 6 months. In total, 15.2% (n = 202) died within 6 months. In the gender- and age-adjusted analysis, a lower EQ5D index score was associated with a higher hazard ratio (HR) of unplanned readmission or death without prior readmission for all categories of scores below 1 (< 1 to 0.741, < 0.741 to 0.438 and < 0.438 to - 0.40), HR 1.60, 1.93 and 2.02. Likewise, a lower EQ5D score was associated with a higher HR of death, HR 1.72, 2.54 and 3.79. Harrell's C values were 0.56 and 0.63. CONCLUSION: HRQOL measured at discharge may identify acutely admitted older medical patients at especially high risk of readmission or death up to 6 months after discharge. Incorporating assessment of HRQOL should be considered when risk stratifying a heterogeneous population of acutely admitted older medical patients.
PURPOSE: To assess whether health-related quality of life (HRQOL) status, using the European Quality of life-5 dimensions (EQ5D), in acutely admitted older medical patients was associated with a combined end-point including first unplanned readmission or death without prior readmission within 6 months. Secondly, to assess if HRQOL was associated with death regardless of previous readmissions. METHODS:Patients from seven medical and two acute medical units were included and the EQ5D was obtained at discharge. Associations were assessed using Cox regression. Harrell's C-statistics indicated the predictive performance. RESULTS: 1328 patients were included, 50% (n = 664) were readmitted (n = 635) or had died without prior readmission (n = 29) within 6 months. In total, 15.2% (n = 202) died within 6 months. In the gender- and age-adjusted analysis, a lower EQ5D index score was associated with a higher hazard ratio (HR) of unplanned readmission or death without prior readmission for all categories of scores below 1 (< 1 to 0.741, < 0.741 to 0.438 and < 0.438 to - 0.40), HR 1.60, 1.93 and 2.02. Likewise, a lower EQ5D score was associated with a higher HR of death, HR 1.72, 2.54 and 3.79. Harrell's C values were 0.56 and 0.63. CONCLUSION: HRQOL measured at discharge may identify acutely admitted older medical patients at especially high risk of readmission or death up to 6 months after discharge. Incorporating assessment of HRQOL should be considered when risk stratifying a heterogeneous population of acutely admitted older medical patients.
Entities:
Keywords:
Cohort study; Denmark; EQ5D; Health-related quality of life; Older medical in-patients; Readmission or mortality
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