Discharge Disposition in Veterans with Heart Failure: Impact of Dementia and Severe Mental Illness.

Howe MD, Jiang L, Browne JW, Bayer TA, Kunicki ZJ, De Vito AN, McGeary JE, Wu WC, Lind JD, Kelso CM, Rudolph JL. Discharge Disposition in Veterans with Heart Failure: Impact of Dementia and Severe Mental Illness. Journal of The American Medical Directors Association. 2025 Mar 10; 26(5):105533, DOI: 10.1016/j.jamda.2025.105533.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVES: Post-acute heart failure (HF) care presents significant management challenges, particularly among veterans with cognitive and behavioral impairments due to Alzheimer disease and related dementias (AD/ADRD) or severe mental illness (SMI). We hypothesized that comorbid AD/ADRD and SMI would reduce the likelihood of discharge home following HF hospitalization. In addition, we explored how AD/ADRD and SMI influence discharge to Veterans Affairs (VA) Community Living Centers (CLCs) compared with Medicare Skilled Nursing Facilities (SNFs). DESIGN: Retrospective cohort study spanning January 1, 2011, to September 30, 2019. SETTING AND PARTICIPANTS: Veterans hospitalized with acute HF at VA hospitals (n  = 291,117). METHODS: We examined VA administrative data from HF hospitalizations to assess how AD/ADRD and SMI impact post-hospital discharge location. Using diagnostic codes from the prior year, we stratified participants by the presence of AD/ADRD and/or SMI, then employed logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for discharge location, adjusted for demographics, comorbidities, and health care utilization. RESULTS: Participants were predominantly older (mean age: 78.1 ± 11.1 years), male (97.5%), and self-identified as white (72.7%). Those with AD/ADRD alone (n  = 16,212) or SMI alone (n  = 33,194) outnumbered those with both conditions (n  = 3612). Compared with neither condition, the presence of AD/ADRD alone [adjusted OR (aOR), 0.523; 95% CI, 0.505-0.542], SMI alone (aOR, 0.869; 95% CI, 0.843-0.896), and both conditions (aOR, 0.505; 95% CI, 0.47-0.542) all reduced likelihood of discharge home. Participants with AD/ADRD and SMI were more likely to be discharged to a CLC than a SNF (aOR, 1.225; 95% CI, 1.064-1.411). CONCLUSIONS AND IMPLICATIONS: Our findings indicate that AD/ADRD and SMI are major barriers to discharge home for patients with HF, suggesting a need for enhanced supervision during health care transitions. This study calls for further research into how discharge location affects short- and long-term clinical outcomes in patients with cognitive and behavioral impairment.