Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 13:S0025-6196(17)30087-3.
doi: 10.1016/j.mayocp.2017.01.014. Online ahead of print.

Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study

Sheila M Manemann  1 , Alanna M Chamberlain  1 , Cynthia M Boyd  2 , Susan A Weston  1 , Jill Killian  1 , Cynthia L Leibson  1 , Andrea Cheville  3 , Jennifer St Sauver  1 , Shannon M Dunlay  4 , Ruoxiang Jiang  1 , Véronique L Roger  5
Affiliations

Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study

Sheila M Manemann et al. Mayo Clin Proc. .

Abstract

Objectives: To examine the effect of skilled nursing facility (SNF) use on hospitalizations in patients with heart failure (HF) and to examine predictors of hospitalization in patients with HF admitted to a SNF.

Patients and methods: Olmsted County, Minnesota, residents with first-ever HF from January 1, 2000, through December 31, 2010, were identified, and clinical data were linked to SNF utilization data from the Centers for Medicare and Medicaid Services. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization.

Results: Of 1498 patients with incident HF (mean ± SD age, 75±14 years; 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median follow-up, 3.6 years; range, 0-13.0 years). Of those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction, and comorbidities, SNF use was associated with a 50% increased risk of hospitalization compared with no SNF use (adjusted hazard ratio, 1.52; 95% CI, 1.31-1.76). In SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living requiring assistance were independently associated with an increased risk of hospitalization.

Conclusion: Approximately 40% of patients with HF were admitted to a SNF at some point after diagnosis. Compared with SNF nonusers, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization in SNF users were mostly noncardiovascular, including reduced ability to perform activities of daily living. These findings underscore the effect of physical functioning on hospitalizations in patients with HF in SNFs and the importance of strategies to improve physical functioning.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Linkage of comprehensive community medical records to skilled nursing facility data.
Figure 2
Figure 2
Number of skilled nursing facility admissions per person after HF diagnosis according to ejection fraction.
Figure 3
Figure 3
Fully-adjusted predictors of hospitalizations among heart failure patients in a skilled nursing facility. aTreated as time dependent covariates. bP<.05 ADL=activity of daily living
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154–235. - PubMed
    1. Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391–479. - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the american heart association. Circ Heart Fail. 2013;6(3):606–619. - PMC - PubMed
    1. Jurgens CY, Goodlin S, Dolansky M, et al. Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circ Heart Fail. 2015;8(3):655–687. - PubMed
    1. Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Affairs. 2010;29(1):57–64. - PMC - PubMed