Post-acute care services received by older adults following a cardiac event: a population-based analysis.
BACKGROUND
Post-acute care (PAC) is available for older adults who need additional services after hospitalization for acute cardiac events. With the aging population and an increase in the prevalence of cardiac disease, it is important to determine current PAC use for cardiac patients to assist health care workers to meet the needs of older cardiac patients. The purpose of this study was to determine the current PAC use and factors associated with PAC use for older adults following hospitalization for a cardiac event that includes coronary artery bypass graft and valve surgeries, myocardial infarction (MI), percutaneous coronary intervention (PCI), and heart failure (HF).


RESULTS
A cross-sectional design and the 2003 Medicare part A database were used for this study. The sample (n = 1493521) consisted of patients 65 years and older discharged after their first cardiac event. Multinomial logistic regression was used to examine factors associated with PAC use. Overall, PAC use was 55% for cardiac valve surgery, 50% for MI, 45% for HF, 44% for coronary artery bypass graft, and 5% for PCI. Medical patients use more skilled nursing facility care, and surgical patients use more home health care. Only 0.1% to 3.4% of the cardiac patients use intermediate rehabilitation facilities. Compared with those who do not use PAC, those who use home health care and skilled nursing facility care are older and female, have a longer hospital length of stay, and have more comorbidity. Asians, Hispanics, and Native Americans were less likely to use PAC after hospitalization for an MI or HF.


CONCLUSIONS
The current rate of PAC use indicates that almost half of nondisabled Medicare patients discharged from the hospital following a cardiac event use one of these services. Health care professionals can increase PAC use for Asians, Hispanics, and Native Americans by including culturally targeted communication. Optimizing recovery for cardiac patients who use PAC may require focused cardiac rehabilitation strategies.
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA. Mary.dolansky@case.edu
Mary A
MA
Dolansky
Fang
F
Xu
Melissa
M
Zullo
Mehdi
M
Shishehbor
Shirley M
SM
Moore
Alfred A
AA
Rimm
D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D018672:Community Health Planning; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006331:Heart Diseases / Q000517:prevention & control / Q000523:psychology; D006699:Home Care Services / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data; D020380:Needs Assessment; D015404:Nursing Methodology Research; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010351:Patient Discharge; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States