Abstract MP69: Nursing facility use and frailty index as indicators of reserve and resilience in adults with hospitalization for a cardiovascular event: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Abstract

Introduction: Reserve and resilience refer to the degree of robustness prior to, and the subsequent ability to recover from a health stressor. Frailty and nursing facility use (NFU) may characterize varying levels of physical reserve and resilience among individuals hospitalized for a cardiovascular event. Objective: To characterize older US adults who had a CVD hospitalization using novel indicators of reserve and resilience: nursing facility use and a frailty index. Methods: We analyzed data from 1,605 Black and White REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with Medicare fee-for-service coverage who were age ≥65.5 years and had no NFU before an adjudicated myocardial infarction, heart failure, or stroke hospitalization in 2004-2019. Participants were grouped into mutually exclusive categories based on Medicare claims for NFU and vital status (i.e., alive without NFU, alive with NFU, and death) within 182 days and 183-365 days following discharge. We calculated a claims-based frailty index (index ranges from 0 to 1, with higher values indicating greater deficit accumulation) within 182 days before admission, and within 182 days and 183-365 days following discharge. Results: The mean age at admission was 77.4 years, 43.6% were female, and 30.4% were Black. Most participants were alive without NFU for 365 days post-discharge (64.9%), followed by those who died within 182 days following discharge (11.6%), and those who were alive with NFU within 182 days and alive without NFU in the 183-365 days following discharge (10.3%). Participants who were alive without NFU for 365 days post-discharge had the lowest frailty index in each assessment period (Figure) and were younger (mean age 76.5 years) versus the other groups (range 77.3-80.4 years). There were no substantial differences in subgroups defined by NFU and vital status post-discharge in analyses stratified by sex or race. Conclusion: NFU and frailty index identify older adults with varying levels of apparent reserve and resilience before and after a cardiovascular hospitalization.