Objectives: To identify vulnerable cardiovascular patients in the hospital using a self-reported functionbased screening tool. Participants: 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.
Bell, S. P., Schnelle, J., Nwosu, S. K., Schildcrout, J., Goggins, K., Cawthon, C., … Kripalani, S. (2015). Development of a multivariable model to predict Vulnerability in older American patients hospitalised with cardiovascular disease. BMJ Open, 5(8). https://doi.org/10.1136/bmjopen-2015-008122