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Title: | Geriatric co-management for cardiology patients in the hospital: A quasi-experimental study | Authors: | Van Grootven, Bastiaan Jeuris, Anthony Jonckers, Maren Devriendt, Els Dierckx de Casterle, Bernadette Dubois, Christophe Fagard, Katleen Herregods, Marie-Christine Hornikx, Miek Meuris, Bart Rex, Steffen Tournoy, Jos Milisen, Koen Flamaing, Johan DESCHODT, Mieke |
Issue Date: | 2021 | Publisher: | WILEY | Source: | JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 69 (5), p. 1377-1387 | Abstract: | Background/Objectives Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. Design A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. Setting Two cardiac care units of the University Hospitals Leuven. Participants One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes. | Notes: | Deschodt, M (corresponding author), UZ, Dept Gerontol & Geriatr, AGSF, Herestr 49 Box 7003 35, B-3000 Leuven, Belgium. mieke.deschodt@kuleuven.be |
Other: | Deschodt, M (corresponding author), UZ, Dept Gerontol & Geriatr, AGSF, Herestr 49 Box 7003 35, B-3000 Leuven, Belgium. mieke.deschodt@kuleuven.be | Keywords: | activities of daily living;cardiogeriatrics;co‐management;disability;functional status | Document URI: | http://hdl.handle.net/1942/33975 | ISSN: | 0002-8614 | e-ISSN: | 1532-5415 | DOI: | 10.1111/jgs.17093 | ISI #: | WOS:000629708400001 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
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Effectiveness paper GCOACH_final.pdf | Peer-reviewed author version | 323.36 kB | Adobe PDF | View/Open |
J American Geriatrics Society - 2021 - Van Grootven - Geriatric co‐management for cardiology patients in the hospital A.pdf Restricted Access | Published version | 1.14 MB | Adobe PDF | View/Open Request a copy |
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