Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study |
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Institution: | 1. Department of Health Sciences Research, Mayo Clinic, Rochester, MN;2. Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN;3. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN;4. Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD;5. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD;2. Department of Gerontology and Geriatric Medicine, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD;3. Dartmouth Centers for Health and Aging, Community & Family Medicine, The Dartmouth Medical School, Lebanon, NH;1. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX;2. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX;3. Division of Oncology, University of Texas Southwestern Medical Center, Dallas, TX;4. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX;5. Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX;6. Department of Clinical Cancer Prevention and Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX;1. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy;2. Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy;3. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy;4. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy |
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Abstract: | ObjectivesTo 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 MethodsOlmsted 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.ResultsOf 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.ConclusionApproximately 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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Keywords: | ADLs"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"activities of daily living CAD"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"coronary artery disease CMS"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"Centers for Medicare and Medicaid Services COPD"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"chronic obstructive pulmonary disease EF"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"ejection fraction GWTG-HF"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"Get With the Guidelines–HF HF"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"heart failure HR"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"hazard ratio MDS"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"Minimum Data Set REP"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"Rochester Epidemiology Project SNF"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"skilled nursing facility |
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