title: Nursing Home Use After Implantable Cardioverter-Defibrillator Implantation in Older Adults: Results from the National Cardiovascular Data Registry.
abstract: OBJECTIVE
  To evaluate the incidence and characteristics of nursing home (NH) use after implantable cardioverter-defibrillator (ICD) implantation.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Medicare beneficiaries in the National Cardiovascular Data Registry-ICD Registry.
  
  
  METHODS
  Individuals aged 65 and older receiving ICDs between January 1, 2006, and March 31, 2010 (N = 192,483).
  
  
  METHODS
  Proportion of ICD recipients discharged to NHs directly after device placement, cumulative incidence of long-term NH admission, and factors associated with immediate discharge to a NH and time to long-term NH admission.
  
  
  RESULTS
  Over 4 years, 40.6% of the cohort died, and 35,939 (18.7%) experienced at least one NH admission, including 4.0% directly discharged to a NH after ICD implantation and 2.8% admitted to long-term NH care during follow-up. The cumulative incidence of long-term NH admission, accounting for the competing risk of death, was 1.7% at 1 year, 3.8% at 3 years, and 4.6% at 4 years; 20.1% of individuals admitted to a NH died there. Factors most strongly associated with direct NH discharge and time to long-term NH care were older age (adjusted odds ratio (AOR) = 2.09, 95% confidence interval (CI) = 2.01-2.17 per 10-year increment; adjusted hazard ratio (AHR) = 1.88, 95% CI = 1.80-1.97, respectively), dementia (AOR = 2.60, 95% CI = 2.25-3.01; AHR = 2.50, 95% CI = 2.14-2.93, respectively), and Medicare Part A claim for NH stay in prior 6 months (AOR = 3.96, 95% CI = 3.70-4.25; AHR = 2.88, 95% CI = 2.65-3.14, respectively).
  
  
  CONCLUSIONS
  Nearly one in five individuals are admitted to NHs over a median of 1.6 years of follow-up after ICD implantation. Understanding these outcomes may help inform the clinical care of these individuals.
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, MA.|Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kramer
authors.affiliation: Harvard Clinical Research Institute, Boston, MA.|Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.|Department of Biostatistics, Havard TH Chan School of Public Health, Boston, MA.
authors.forename: Sharon-Lise
authors.initials: SL
authors.lastname: Normand
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University, New Haven, Connecticut.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Parzynski
authors.affiliation: Mid America Heart Institute, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Department of Health Services, Policy and Practice, Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D003704:Dementia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016344:Medicare Part A; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012042:Registries; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: aging; implantable cardioverter-defibrillators; outcomes