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. 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.

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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

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