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

March 29, 2017, Mayo Clinic

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

Hot cars can hit deadly temperatures in as little as one hour

May 24, 2018
A lot can happen at 160 degrees Fahrenheit: Eggs fry, salmonella bacteria dies, and human skin will suffer third-degree burns. If a car is parked in the sun on a hot summer day, its dashboard can hit 160 degrees in about ...

Research finds a little exercise does a lot of good for ageing muscles

May 24, 2018
Getting old doesn't necessarily mean getting weak and frail – just a little bit of exercise can help maintain muscle mass and strength, Otago research has revealed.

In helping smokers quit, cash is king, e-cigarettes strike out

May 23, 2018
Free smoking cessation aids, such as nicotine patches and chewing gum, are a staple of many corporate wellness programs aimed at encouraging employees to kick the habit. But, new research shows that merely offering such aids ...

What makes us well? Diversity, health care, and public transit matter

May 23, 2018
Diverse neighbors. Health centers. Commuter trains. These community attributes, and other key factors, are linked to well-being and quality of life, according to Yale researchers.

Time spent sitting at a screen matters less if you are fit and strong

May 23, 2018
The impact of screen time on cardiovascular disease, cancer incidence and mortality may be greatest in people who have lower levels of grip-strength, fitness and physical activity, according to a study published in the open ...

Widely used e-cigarette flavoring impairs lung function

May 23, 2018
A new study has found that a common e-cigarette flavoring that has chemical characteristics similar to toxic chemicals found in cigarette smoke disrupts an important mechanism of the lungs' antibacterial defense system. The ...

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.