Nursing Home Admission and Initiation of Domiciliary Care Following Infective Endocarditis

BACKGROUND: Infective endocarditis (IE) may cause debilitating physical and mental changes that can interfere with activities of daily living. Admission to a nursing home and need for domiciliary care following hospitalization for IE represent such relevant outcomes, yet no such data have been reported.

METHODS: Using Danish nationwide registries, we identified all patients discharged alive after a first-time IE hospitalization in the period 1996 to 2014. These were matched by age, sex, calendar year, and relevant comorbidities with the background population in a 1:1 ratio. The 1-year rate of nursing home admission and initiation of domiciliary care, respectively, were assessed by multivariable Cox regression analyses.

RESULTS: In total, 4,493 IE patients were matched with 4,493 control subjects from the background population (median age: 66.8 years; interquartile range: 54.1, 76.7; 67.8% men). The 1-year incidence of nursing home admission was significantly higher among IE patients compared with the matched population (3.4% vs. 1.0%; hazard ratio: 7.95; 95% confidence interval: 4.00-15.77). Furthermore, IE patients had an increased use of domiciliary care compared with the matched population (6.6% vs. 2.1%; hazard ratio: 4.39; 95% confidence interval: 2.74-7.05). Factors associated with an increased risk of nursing home admission and domiciliary care among IE patients included older age, living alone, longer length of hospital stay, cardiovascular comorbidities, and stroke during admission.

CONCLUSIONS: Patients who survived IE had an 8× higher incidence of nursing home admission and a 4× higher incidence of initiation of domiciliary care than their counterparts from the matched population.