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 new research in Circulation: Heart Failure, an American Heart Association journal.
“Patients hospitalized with heart failure are high risk to start with,” researchers said in a release. “If they have to go to a skilled nursing facility, patients, families and providers shouldn't be under the impression that life will, necessarily, go back to normal. We should help patients and their families recognize this high risk and adjust their medical decision making appropriately.”
Heart failure affects nearly 6 million Americans, and is the primary cause of hospitalizations among Medicare patients, according to the American Heart Association.
For the study, 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. Patients' average age was 80, most were white, and 55% were female.
According to the study, there was a higher re-hospitalization rate among patients discharged to skilled nursing facilities. Thirty days after initial hospital discharge, 27% of patients discharged to skilled nursing facilities were re-hospitalized for any cause, compared to 24% of patients discharged to home. One year after discharge, re-hospitalizations were common in both groups, although the difference between them remained steady, with 76% of skilled nursing and 72% of home patients readmitted to the hospital. Patients discharged to skilled nursing facilities were more likely than other patients to be older, female, hospitalized longer, and to have other complications in addition to heart failure.
The researchers also found that:
· About one-fourth of patients were discharged to a skilled nursing facility.
· Thirty days post-discharge, 14% of patients discharged to skilled nursing facilities had died of any cause, compared to 4% of those who returned home from the hospital.
· At one year, 54% of patients discharged to skilled nursing facilities had died of any cause, compared to 29% of patients discharged to home.
“Even after adjusting for patient differences, a strong predictor of mortality in the next year was discharge to a skilled nursing facility,” researchers said. “This has important implications for talking to patients and their families during the initial hospitalization for heart failure.”