Heart Failure Patients Needing Skilled Nursing Care Often Sicker, Have Poorer Outcomes

Elderly patients with heart failure who need skilled nursing care after hospital discharge are often sicker, at higher risk for poor outcomes and are more likely than other patients to die or be re-hospitalized within one year, according to research reported in Circulation: Heart Failure, an American Heart Association journal.

Heart failure affects nearly 6 million Americans, and is the primary cause of hospitalizations among Medicare patients. Although many of these patients are discharged to skilled nursing facilities, the type of treatment they receive often varies.

Researchers analyzed data on 15,459 Medicare patients—enrolled in the American Heart Association’s Get With The Guidelines-Heart Failure program at 149 hospitals in 2005 and 2006—and discharged from the hospital after three or more days of heart failure treatment. The average patient age was 80, most were white and 55 percent were female. The researchers found that:

● About one-fourth of patients were discharged to a skilled nursing facility.

● Thirty days post-discharge, 14 percent of patients discharged to skilled nursing facilities had died of any cause, compared to 4 percent of those who returned home from the hospital.

● In one year, 54 percent of patients discharged to skilled nursing facilities had died of any cause, compared to 29 percent of patients discharged to home.

Furthermore, there was a higher rehospitalization rate among patients discharged to skilled nursing facilities. Thirty days after initial hospital discharge, 27 percent of patients discharged to skilled nursing facilities were rehospitalized for any cause, compared to 24 percent of patients discharged to home.

Skilled nursing use varied by region. The highest rate was in the northeastern United States, where nearly one-third of heart-failure patients left the hospital for skilled nursing facilities. The lowest was in the West, where about one-fourth required this type of care.

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Study: “Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure”

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