{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:24:26Z","timestamp":1792110266958,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T00:00:00Z","timestamp":1708732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Designs, Settings, and Participants<\/jats:title><jats:p>This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome and Measures<\/jats:title><jats:p>The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES\u201013).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR]\u2009=\u20091.36, 95% confidence interval [CI]: 1.06\u20131.75) in the first 90 days after discharge. The VES\u201013 score was not associated with readmission for cardiovascular causes (RRR\u2009=\u20090.94, 95% CI: 0.75\u20131.17).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES\u201013 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.13316","type":"journal-article","created":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:09:05Z","timestamp":1708819745000},"page":"386-393","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Vulnerability to functional decline is associated with noncardiovascular cause of 90\u2010day readmission in hospitalized patients with heart failure"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-7480","authenticated-orcid":false,"given":"Ricardo J.","family":"Trochez","sequence":"first","affiliation":[{"name":"Center for Health Services Research Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer B.","family":"Barrett","sequence":"additional","affiliation":[{"name":"Center for Health Services Research Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaping","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Schildcrout","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Rick","sequence":"additional","affiliation":[{"name":"\u00a0Department of Medicine, Division of Geriatric Medicine Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7164-715X","authenticated-orcid":false,"given":"Devika","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology &amp; Hypertension Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation Vanderbilt University Medical Center Nashville Tennessee USA"},{"name":"Department of Veterans Affairs, Geriatric Research Education and Clinical Center(GRECC) Tennessee Valley Healthcare System Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam A.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan P.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4214-7129","authenticated-orcid":false,"given":"Sunil","family":"Kripalani","sequence":"additional","affiliation":[{"name":"Center for Health Services Research Vanderbilt University Medical Center Nashville Tennessee USA"},{"name":"Section of Hospital Medicine, Department of Medicine, Division of General Internal Medicine &amp; Public Health Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,24]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"McDermottKW RoemerM.Most frequent principal diagnoses for inpatient stays in U.S hospitals.2018. Accessed May 1 2023.https:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb277-Top-Reasons-Hospital-Stays-2018.pdf"},{"key":"e_1_2_8_3_1","unstructured":"WeissAJ JiangHJ.Overview of clinical conditions with frequent and costly hospital readmissions by payer.2018. Accessed May 1 2023.https:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb278-Conditions-Frequent-Readmissions-By-Payer-2018.jsp"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2015.09.004"},{"key":"e_1_2_8_5_1","unstructured":"Centers for Medicare & Medicaid Services. Outcome and payment measures. Accessed May 1 2023.https:\/\/www.cms.gov\/medicare\/quality-initiatives-patient-assessment-instruments\/hospitalqualityinits\/outcomeandpaymentmeasures"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h411"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2022.09.006"},{"issue":"6","key":"e_1_2_8_8_1","first-page":"698","article-title":"Worse prognosis in heart failure patients with 30\u2010day readmission","volume":"32","author":"Tung YC","year":"2016","journal-title":"Acta Cardiol Sin"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1212324"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5100"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2019.04.010"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-008122"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2011.227504"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.07.008"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49281.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00615.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2019.08.010"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.042"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.2572"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005082-200004000-00004"},{"key":"e_1_2_8_20_2","unstructured":"quiz88\u201089."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.22.2481"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.216476"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00008"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-022613-090415"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-10"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02497.x"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000551"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.6736"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jopan.2019.01.004"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-21706-2"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0924"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.09.038"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-014-9459-2"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2003.51471.x"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1991.tb05927.x"},{"key":"e_1_2_8_35_2","unstructured":"Discussion7S\u20138S."},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2023.01.011"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glz017"},{"issue":"18","key":"e_1_2_8_38_1","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American college of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"145","author":"Heidenreich PA","year":"2022","journal-title":"Circulation"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.02.023"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-017-0885-6"},{"issue":"4","key":"e_1_2_8_41_1","first-page":"329","article-title":"Management of chronic heart failure in the older population","volume":"11","author":"Azad N","year":"2014","journal-title":"J Geriatr Cardiol"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.13316","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T18:09:24Z","timestamp":1760638164000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.13316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,24]]},"references-count":42,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1002\/jhm.13316"],"URL":"https:\/\/doi.org\/10.1002\/jhm.13316","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,24]]},"assertion":[{"value":"2023-10-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}