Heart failure and skilled nursing facilities: The importance of getting the facts

March 29, 2017

For many people diagnosed with heart failure—which almost invariably results in a hospital stay—the next stop is a skilled nursing facility. While their physician often will reassure them that it's just for a short time until they can get back to their home, in reality, that stay is long (averaging 144 days). And often they find themselves back in the hospital and back to a nursing facility again.

In a new study published in Mayo Clinic Proceedings, Mayo Clinic researchers and collaborators report new understanding and new hope for .

"We really wanted to understand the complete experience of patients," says Sheila Manemann, a researcher at Mayo Clinic and the study's first author.

"To do so, we needed to look at not just outpatient and information, but that from skilled nursing facilities," she says. "This required linked data from across the community and across the lives of these patients."

The team studied the of 1,498 patients who were residents of Olmsted County, Minnesota, between Jan. 1, 2000, and Dec. 31, 2010, and initially diagnosed with heart failure during that time.

"After adjusting for various contributing risk factors and conditions, we found that being in a skilled nursing facility means a heart failure patient is 50 percent more likely to end up back in the hospital than patients who were able to return home," says Manemann.

Using linked medical records from the Rochester Epidemiology Project, a unique resource that enables longitudinal, population-based epidemiologic studies across an entire community, the research team was able to examine detailed medical information from nearly all sources of care. They connected this to skilled nursing facility usage information obtained from the Centers for Medicare & Medicaid Services.

The team found that more than 40 percent of heart failure patients were admitted to a skilled nursing facility at some point after diagnosis. Among these, 37 percent were discharged only to return to a skilled nursing facility at least two more times.

The researchers also learned that, in general, hospital readmissions for patients from a skilled nursing facility were for reasons unrelated to cardiovascular function.

Learning these facts, "we wanted to try to identify ways to improve outcomes for patients released to a skilled nursing facility, as well as potentially for patients overall," says Véronique Roger, M.D., a cardiologist at Mayo Clinic and the study's senior author.

The team determined that one of the key factors in estimating a person's likelihood to be readmitted to the hospital during a stay in a skilled nursing facility is his or her general ability to carry on the activities of daily living upon entering the facility.

"The level of activity a patient has when he or she enters a skilled nursing facility is an important predictor of whether he or she will be readmitted to the hospital and how [he or she] will do in the long term," states Dr. Roger.

Understanding this opens the door for more informed patient-doctor conversations, as well as potential health and wellness interventions.

"For me and my colleagues, it is important for us to understand the other conditions that travel with heart failure," says Dr. Roger. "We need to understand the big picture to be able to treat the whole patient."

She and her colleagues would like to see programs to increase mobility for heart failure patients in skilled nursing facilities.

"We want to make it much more common that heart failure patients who transition to a skilled nursing facility are able to return home," she says. "Most importantly, we'd like to see healthier individuals able to consistently participate in life activities."

Dr. Roger also supports efforts to increase individual activity levels at all stages of life for better health and wellness - and potentially to prevent heart failure in the first place.

Dr. Roger is the Elizabeth C. Lane, Ph.D., and M. Nadine Zimmerman, Ph.D., Professor of Internal Medicine, and the medical director of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The Rochester Epidemiology Project is a collaboration of clinics, hospitals and other medical facilities in Minnesota and Wisconsin, and involves community members who have agreed to share their medical records for research. It is administratively managed through the center.

Explore further: Readmission from skilled nursing facility often avoidable

Related Stories

Readmission from skilled nursing facility often avoidable

December 22, 2016
(HealthDay)—A considerable proportion of hospital readmissions from skilled nursing facilities (SNFs) are considered potentially avoidable, according to a study published online Dec. 16 in the Journal of the American Geriatrics ...

Longer hospital stays might reduce readmissions from post-acute care facilities

March 7, 2017
More than 25 percent of Medicare beneficiaries who are admitted to the hospital are sent to a post-acute care facility (a health facility like a rehabilitation or skilled nursing center used instead of a hospital) after being ...

Study finds high survival rate for elderly patients with implantable defibrillator

January 16, 2017
Of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac arrest or a near-fatal arrhythmia, almost 80 percent survived two years—a higher rate than found in past ...

High-volume facilities better for nursing hip fractures

September 30, 2015
There isn't a lot of information available to help family caregivers choose the best skilled nursing facility for an elderly loved one who breaks a hip, but a new study suggests a potentially useful quality indicator: the ...

Study: Where hospitals send surgery patients to heal matters a lot for health care costs

January 9, 2017
Thousands of times a day, doctors sign the hospital discharge papers for patients who have just had surgery, and send them off to their next destination. About half of those patients will get some sort of post-surgery care ...

Recommended for you

Amber-tinted glasses may provide relief for insomnia

December 15, 2017
How do you unwind before bedtime? If your answer involves Facebook and Netflix, you are actively reducing your chance of a good night's sleep. And you are not alone: 90 percent of Americans use light-emitting electronic devices, ...

Warning labels can help reduce soda consumption and obesity, new study suggests

December 15, 2017
Labels that warn people about the risks of drinking soda and other sugar-sweetened beverages can lower obesity and overweight prevalence, suggests a new Johns Hopkins Bloomberg School of Public Health study.

Office work can be a pain in the neck

December 15, 2017
Neck pain is a common condition among office workers, but regular workplace exercises can prevent and reduce it, a University of Queensland study has found.

Regular takeaways linked to kids' heart disease and diabetes risk factors

December 14, 2017
Kids who regularly eat take-away meals may be boosting their risk factors for heart disease and diabetes, suggests research published online in the Archives of Disease in Childhood.

Simulation model finds Cure Violence program and targeted policing curb urban violence

December 14, 2017
When communities and police work together to deter urban violence, they can achieve better outcomes with fewer resources than when each works in isolation, a simulation model created by researchers at the UC Davis Violence ...

One in five patients report discrimination in health care

December 14, 2017
Almost one in five older patients with a chronic disease reported experiencing health care discrimination of one type or another in a large national survey that asked about their daily experiences of discrimination between ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.