title: Association between having a caregiver and clinical outcomes 1 year after hospitalization for cardiovascular disease.
abstract: Caregivers might represent an opportunity to improve cardiovascular disease outcomes, but prospective data are limited. We studied 3,188 consecutive patients (41% minority, 39% women) admitted to a university hospital medical cardiovascular service to evaluate the association between having a caregiver and rehospitalization/death at 1 year. The clinical outcomes at 1 year were documented using a hospital-based clinical information system supplemented by a standardized questionnaire. Co-morbidities were documented by hospital electronic record review. At baseline, 13% (n = 417) of the patients had a paid caregiver and 25% (n = 789) had only an informal caregiver. Having a caregiver was associated with rehospitalization or death at 1 year (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.45 to 1.95), which varied by paid (OR 2.46, 95% CI 1.96 to 3.09) and informal (OR 1.40, 95% CI 1.18 to 1.65) caregiver status. Having a caregiver was significantly (p <0.05) associated with age ≥65 years, racial/ethnic minority, lack of health insurance, medical history of diabetes mellitus or hypertension, a Ghali co-morbidity index >1, chronic obstructive pulmonary disease, or taking ≥9 prescriptions medications. The relation between caregiving and rehospitalization/death at 1 year was attenuated but remained significant after adjustment (paid, OR 1.64, 95% CI 1.26 to 2.12; and informal, OR 1.20, 95% CI 1.00 to 1.44). In conclusion, the risk of rehospitalization/death was significantly greater among cardiac patients with caregivers and was not fully explained by the presence of traditional co-morbidities. Systematic determination of having a caregiver might be a simple method to identify patients at a heightened risk of poor clinical outcomes.
authors.affiliation: Columbia University Medical Center, New York-Presbyterian Hospital, New York, USA. Ljm10@columbia.edu
authors.forename: Lori
authors.initials: L
authors.lastname: Mosca
authors.forename: Brooke
authors.initials: B
authors.lastname: Aggarwal
authors.forename: Heidi
authors.initials: H
authors.lastname: Mochari-Greenberger
authors.forename: Ming
authors.initials: M
authors.lastname: Liao
authors.forename: Judith
authors.initials: J
authors.lastname: Blair
authors.forename: Bin
authors.initials: B
authors.lastname: Cheng
authors.forename: Mariceli
authors.initials: M
authors.lastname: Comellas
authors.forename: Lisa
authors.initials: L
authors.lastname: Rehm
authors.forename: Niurka
authors.initials: N
authors.lastname: Suero-Tejeda
authors.forename: Tianna
authors.initials: T
authors.lastname: Umann
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D017028:Caregivers / Q000600:supply & distribution*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D009017:Morbidity / Q000639:trends; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends