Heart FailureeRelated Mortality and Hospitalization in the Year Following Admission to a Long-Term Care Facility: The Geriatric Outcomes and Longitudinal Decline in Heart Failure (GOLD-HF) Study ANDREA D. FOEBEL, PhD, 1 GEORGE A. HECKMAN, MD, MSc, 1,2 KEXIN JI, MSc, 3 JOEL A. DUBIN, PhD, 3 IRENE D. TURPIE, MB, 4 PATRICIA HUSSACK, RN, 5 AND ROBERT S. MCKELVIE, MD, PhD 4 Waterloo and Hamilton, Ontario, Canada ABSTRACT Background: Heart failure (HF) is common in long-term care facilities (LTCs). This study compared mortality and hospitalization rates and examined predictors of these outcomes among new LTC residents with and without HF. Methods and Results: This prospective cohort study followed 546 newly admitted residents from 42 LTCs for up to 1 year. Health information was collected from participant and caregiver interviews, phy- sicians’ records, diagnostic procedures, and hospitalization records. Multivariate logistic regression mod- eling determined predictors of hospitalization among residents, and Cox proportional hazards regression determined predictors for time to mortality. HF prevalence was 21.4%. The sample was predominantly (O70%) female, and individuals with HF were significantly older with higher prevalence of reduced left ventricular ejection fraction. Overall annual mortality and hospitalization rates were 24% and 27%, respectively. Among residents with HF, 42% died and 31% were hospitalized within 1 year. Among res- idents with HF, use of major tranquilizers was the strongest predictor of sooner mortality; use of antico- agulants and major tranquilizers also increased mortality risk, whereas higher baseline function was associated with longer time to mortality. History of peripheral vascular disease was the strongest predictor of hospitalizations among residents with HF, and use of antiplatelet agents and history of any smoking exposure increased this risk. Conclusions: Among LTC residents, HF is associated with high mortality and hospitalization rates. Many factors contribute to mortality and hospitalizations among residents with HF, and comprehensive HF man- agement programs are needed to improve outcomes. (J Cardiac Fail 2013;19:468e477) Key Words: Outcomes, hospitalization, chronic disease management, skilled nursing facility, heart failure. Population aging is associated with a rising burden of heart failure (HF). 1,2 The prevalence of HF rises with age, from !1% among people !55 years old to almost 20% of octogenarians. 3,4 The burden from this condition is projected to double by 2025, with the most rapid growth expected among individuals O85 years old. 5 HF is particularly common in long-term care facilities (LTCs) that provide 24-hour on-site nursing care to persons with complex chronic illnesses or disabilities, and for whom community care provision is no longer feasible. 6 A system- atic review shows that the mean prevalence of HF in LTCs is w20%. 7 The burden of HF in LTCs is significant, From the 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; 2 Research Institute for Aging, Waterloo, Ontario, Canada; 3 Department of Statistics and Actuarial Sci- ences, University of Waterloo, Waterloo, Ontario, Canada; 4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada and 5 Divi- sion of Cardiology, McMaster University, Hamilton, Ontario, Canada. Manuscript received April 11, 2012; revised manuscript received May 2, 2013; revised manuscript accepted May 6, 2013. Reprint requests: Dr George A. Heckman, MD, MSc, School of Public Health and Health Systems, Lyle Hallman North, BMH 3732, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1, Canada. Tel: 519-888-4567 ext 31028; fax: 519-894-8326. E-mail: ggheckma@ uwaterloo.ca Funding: Canadian Institutes of Health Research (CIHR) grant no. MOP-64376. CIHR did not play a role in the design or conduct of the study, collection, management, analysis, or interpretation of data or prep- aration, review, or approval of the completed manuscript. See page 475 for disclosure information. 1071-9164/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cardfail.2013.05.003 468 Journal of Cardiac Failure Vol. 19 No. 7 2013