Objective
To examine the impact of skilled nursing facility (SNF) use on hospitalizations among heart failure (HF) patients and to examine predictors of hospitalization among HF patients admitted to a SNF.
Patients and Methods
Olmsted County, MN residents with first-ever HF from 1/1/2000-12/31/2010 were identified and clinical data were linked to SNF utilization data from CMS. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization.
Results
Among 1,498 incident HF patients (mean age 75±14, 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median (min, max) follow-up 3.6 (0-13.0) years). Among those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction and comorbidities, being in a SNF was associated with a 50% increased risk of hospitalization compared to not being in a SNF (adjusted HR, 95% CI: 1.52, 1.31-1.76). Among SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living (ADLs) requiring assistance were independently associated with an increased risk of hospitalization.
Conclusion
Approximately 40% of HF patients were admitted to a SNF at some point after diagnosis. Compared to patients not in a SNF, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization among the SNF users were mostly non-cardiovascular, including reduced ability to perform ADLs. These findings underscore the impact of physical functioning on hospitalizations among HF patients in SNFs and the importance of strategies to improve physical functioning.