Post-Acute Care Medication Use and Functional Recovery in Heart Failure
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PROJECT SUMMARY Many older adults who are hospitalized for heart failure (HF) lose their ability to independently perform activities of daily living and then require long-term custodial care in a nursing home—an outcome that many seniors fear more than death. Yet, research to date on post-hospitalization outcomes has focused on readmission and mortality, and has overlooked important patient-centered outcomes like functional recovery and return to one’s own home. Understanding which factors promote functional recovery is critically necessary. Medications are one of the most easily modifiable potential factors, yet their effects on functional recovery are not well-understood. Thus, the overarching objective of this proposal is to examine the impact of medications on functional recovery and successful transition back to home following a HF hospitalization. The proposed research will focus on older adults discharged to a skilled nursing facility (SNF) after HF hospitalization because: 1) nearly one in five patients require SNF care following HF hospitalization; and 2) patients requiring SNF care are most vulnerable to prolonged functional impairment, loss of independence, and the need for long-term custodial care. The central hypothesis is that many commonly prescribed medications may impair participation in rehabilitation, interfere with functional recovery, and/or decrease the likelihood of successful discharge to home from SNFs. This hypothesis will be tested through three specific aims employing a series of rigorous observational studies: Aim 1, Estimate the effects of HF-specific and other medications administered in SNFs, including dose and duration, on function and successful discharge to home after HF hospitalization (outcomes), and examine potential mediators like rehabilitation minutes and cognition; Aim 2, Develop a novel risk score for the cumulative effects of harmful medications that interfere with function and successful discharge to home after HF hospitalization, and validate its predictive performance for key outcomes and mediators; Aim 3, Quantify individual medication and cumulative medication burden effects on function and successful discharge to home across important pre- defined subgroups of older adults with HF, including by dementia status and varying degrees of frailty, multimorbidity, and polypharmacy. To accomplish the three proposed aims, a large innovative database of SNF electronic health record information will be leveraged along with national Minimum Data Set 3.0 clinical assessment records, Medicare claims, Veterans Health Administration data, and other unique datasets. The proposed research is highly significant because it will provide foundational evidence for developing interventions to optimize medication use patterns (via prescribing and deprescribing) and subsequently facilitate functional recovery after HF hospitalization. This research directly addresses the National Institute on Aging's Strategic Goal C to improve the safe use of medications.
