Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure.
Circ Heart Fail. 2011 Mar 29;
Authors: Allen LA, Hernandez AF, Peterson ED, Curtis LH, Dai D, Masoudi FA, Bhatt DL, Heidenreich PA, Fonarow GC
BACKGROUND: -Heart failure (HF) is the leading cause of hospitalization among older Americans. Subsequent discharge to skilled nursing facilities (SNF) is not well described. METHODS AND RESULTS: -We performed an observational analysis of Medicare beneficiaries ?65 discharged alive to SNF or home following ?3-day hospitalization for HF in 2005 and 2006 within the Get With The Guidelines-HF Program. Among 15,459 patients from 149 hospitals, 24.1% were discharged to a SNF, 22.3% to home with home health service, and 53.6% to home with self care. SNF use varied significantly among hospitals (median 10.2% v. 33.9% in low v. high tertiles), with rates highest in the Northeast. Patient factors associated with discharge to SNF included longer length of stay, advanced age, female gender, hypotension, higher ejection fraction, absence of ischemic heart disease, and a variety of comorbidities. Performance measures were modestly lower for patients discharged to SNF. Unadjusted absolute event rates were higher at 30 days (death 14.4% v. 4.1%, rehospitalization 27.0% v. 23.5%) and 1 year (death 53.5% v. 29.1%, rehospitalization 76.1% v. 72.2%) following discharge to SNF v. home, respectively (p<0.0001 for all). After adjustment for measured patient characteristics, discharge to SNF remained associated with increased death (HR=1.76, 95% CI 1.66-1.87) and rehospitalization (HR=1.08, 95% CI 1.03-1.14). CONCLUSIONS: -Discharge to SNF is common among Medicare patients hospitalized for HF and these patients face substantial risk for adverse events, with over half dead within a year. These findings highlight the need to better characterize this unique patient population and understand the SNF care they receive.
PMID: 21447803 [PubMed - as supplied by publisher]