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Raijmann RCMA, Koek HL, Emmelot-Vonk MH, Swaving JGE, Agema WRP, Kerckhoffs APM, Keijsers CJPW. Impact of geriatric co-management on outcomes in hospitalised cardiology patients aged 85 and over. Neth Heart J 2024; 32:76-83. [PMID: 37651030 PMCID: PMC10834903 DOI: 10.1007/s12471-023-01806-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Cardiovascular disease and frailty are common among the population aged 85+. We hypothesised these patients might benefit from geriatric co-management, as has been shown in other frail patient populations. However, there is limited evidence supporting geriatric co-management in older, hospitalised cardiology patients. METHODS A retrospective cohort study was performed in a large teaching hospital in the Netherlands. We compared patients aged 85 and over admitted to the cardiology ward before (control group) and after the implementation of standard geriatric co-management (intervention group). Data on readmission, mortality, length of stay, number of consultations, delirium, and falls were analysed. RESULTS The data of 1163 patients were analysed (n = 542 control, n = 621 intervention). In the intervention group, 251 patients did not receive the intervention because of logistic reasons or the treating physician's decision. Baseline characteristics were comparable in the intervention and control groups. Patients in the intervention group had a shorter length of stay (-1 day, p = 0.01) and were more often discharged to a geriatric rehabilitation facility (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.10-3.54, p = 0.02) compared with the control patients. Other outcomes were not significantly different between the groups. CONCLUSIONS After implementation of standard geriatric co-management for hospitalised cardiology patients aged 85 and over, the length of hospital stay shortened and the number of patients discharged to a geriatric rehabilitation facility increased. The adherence to geriatric team recommendations was high. Geriatric co-management would appear to optimise care for older hospitalised patients with cardiac disease.
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Affiliation(s)
- Renee C M A Raijmann
- Department of Geriatrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
- Department of Geriatrics, UMC Utrecht, Utrecht, The Netherlands.
| | | | | | | | - Willem R P Agema
- Department of Cardiology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Angèle P M Kerckhoffs
- Department of Geriatrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
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Deschodt M, Van Grootven B, Jeuris A, Devriendt E, Dierckx de Casterlé B, Dubois C, Fagard K, Herregods MC, Hornikx M, Meuris B, Rex S, Tournoy J, Milisen K, Flamaing J. Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study. BMJ Open 2018; 8:e023593. [PMID: 30344179 PMCID: PMC6196878 DOI: 10.1136/bmjopen-2018-023593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Although the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs of frail older patients. Geriatric co-management has demonstrated potential to improve functional status, and reduce complications and length of stay, but evidence on the effectiveness in cardiology patients is lacking. This study aims to determine if geriatric co-management is superior to usual care in preventing functional decline, complications, mortality, readmission rates, reducing length of stay and improving quality of life in older patients admitted for acute heart disease or for transcatheter aortic valve implantation, and to identify determinants of success for geriatric co-management in this population. METHODS AND ANALYSIS This prospective quasi-experimental before-and-after study will be performed on two cardiology units of the University Hospitals Leuven in Belgium in patients aged ≥75 years. In the precohort (n=227), usual care will be documented. A multitude of implementation strategies will be applied to allow for successful implementation of the model. Patients in the after cohort (n=227) will undergo a comprehensive geriatric assessment within 24 hours of admission to stratify them into one of three groups based on their baseline risk for developing functional decline: low-risk patients receive proactive consultation, high-risk patients will be co-managed by the geriatric nurse to prevent complications and patients with acute geriatric problems will receive an additional medication review and co-management by the geriatrician. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Ethics Committee UZ Leuven/KU Leuven (S58296). Written voluntary (proxy-)informed consent will be obtained from all participants at the start of the study. Dissemination of results will be through articles in scientific and professional journals both in English and Dutch and by conference presentations. TRIAL REGISTRATION NUMBER NCT02890927.
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Affiliation(s)
- Mieke Deschodt
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Bastiaan Van Grootven
- Research Foundation, Flanders, Belgium
- Department of Public Health and Primary Care, University of Leuven - KU Leuven, Leuven, Belgium
| | - Anthony Jeuris
- Department of Public Health and Primary Care, University of Leuven - KU Leuven, Leuven, Belgium
| | - Els Devriendt
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Dubois
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Christine Herregods
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Miek Hornikx
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Van Grootven B, Flamaing J, Dierckx de Casterlé B, Dubois C, Fagard K, Herregods MC, Hornikx M, Laenen A, Meuris B, Rex S, Tournoy J, Milisen K, Deschodt M. Effectiveness of in-hospital geriatric co-management: a systematic review and meta-analysis. Age Ageing 2017; 46:903-910. [PMID: 28444116 DOI: 10.1093/ageing/afx051] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 04/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background geriatric consultation teams have failed to impact clinical outcomes prompting geriatric co-management programmes to emerge as a promising strategy to manage frail patients on non-geriatric wards. Objective to conduct a systematic review of the effectiveness of in-hospital geriatric co-management. Data sources MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to 6 May 2016. Reference lists, trial registers and PubMed Central Citations were additionally searched. Study selection randomised controlled trials and quasi-experimental studies of in-hospital patients included in a geriatric co-management study. Two investigators performed the selection process independently. Data extraction standardised data extraction and assessment of risk of bias were performed independently by two investigators. Results twelve studies and 3,590 patients were included from six randomised and six quasi-experimental studies. Geriatric co-management improved functional status and reduced the number of patients with complications in three of the four studies, but studies had a high risk of bias and outcomes were measured heterogeneously and could not be pooled. Co-management reduced the length of stay (pooled mean difference, -1.88 days [95% CI, -2.44 to -1.33]; 11 studies) and may reduce in-hospital mortality (pooled odds ratio, 0.72 [95% CI, 0.50-1.03]; 7 studies). Meta-analysis identified no effect on the number of patients discharged home (5 studies), post-discharge mortality (3 studies) and readmission rate (4 studies). Conclusions there was low-quality evidence of a reduced length of stay and a reduced number of patients with complications, and very low-quality evidence of better functional status as a result of geriatric co-management.
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Affiliation(s)
- Bastiaan Van Grootven
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Clinical and Experimental Medicine, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Christine Herregods
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Miek Hornikx
- Department of Cardiovascular Diseases, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven - University of Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Clinical and Experimental Medicine, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
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