title: Development of a multivariable model to predict vulnerability in older American patients hospitalised with cardiovascular disease.
abstract: OBJECTIVE
  To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool.
  
  
  METHODS
  Prospective observational cohort study of 445 individuals aged ≥ 65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure.
  
  
  METHODS
  Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease.
  
  
  RESULTS
  Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002).
  
  
  CONCLUSIONS
  Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services.
authors: Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA.
authors: Susan P
authors: SP
authors: Bell
authors: Division of General Internal Medicine and Public Health, Department of Medicine, Center for Quality Aging, Vanderbilt University, Nashville, Tennessee, USA.
authors: John
authors: J
authors: Schnelle
authors: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors: Samuel K
authors: SK
authors: Nwosu
authors: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors: Jonathan
authors: J
authors: Schildcrout
authors: Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA.
authors: Kathryn
authors: K
authors: Goggins
authors: Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA.
authors: Courtney
authors: C
authors: Cawthon
authors: Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA Department of Veterans Affairs, Tennessee Valley Healthcare System-Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors: Amanda S
authors: AS
authors: Mixon
authors: Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA Department of Veterans Affairs, Tennessee Valley Healthcare System-Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors: Eduard E
authors: EE
authors: Vasilevskis
authors: Center for Clinical Quality and Implementation Research, Nashville, Tennessee, USA Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA Division of General Internal Medicine and Public Health, Department of Medicine, Section of Hospital Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors: Sunil
authors: S
authors: Kripalani
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D013714:Tennessee; D035862:Vulnerable Populations
keywords: GERIATRIC MEDICINE