Regional Variation in Mortality and Subsequent Hospitalization of Nursing Residents With Heart Failure

Hutt, Evelyn; Elder, Stacey J.; Fish, Ron; Min, Sung‐Joon

doi:10.1016/j.jamda.2010.08.008

Cited by 19 publications

(22 citation statements)

References 25 publications

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“…A significant proportion of patients are discharged to SNFs [34]. In a retrospective study of more than 10,000 patients admitted with HF, 30% were discharged to SNFs [34].…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

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Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days.Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p < 0.10) were included for a multivariate logistic regression model. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p < 0.05 level of significance.Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p < 0.0087) and ADLs (p < 0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine was associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs were over 9 times more likely to be readmitted within 30 days (OR = 9.25) as compared to patients who are independent.

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“…A significant proportion of patients are discharged to SNFs [34]. In a retrospective study of more than 10,000 patients admitted with HF, 30% were discharged to SNFs [34].…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

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“…The precise prevalence of HF among SNF residents is unknown, with estimates ranging between 20% and 37.4%. 2,[16][17][18][19] Of the estimated 1 492 200 Americans (nearly 0.5% of the total US population) living as long-term residents in SNFs, 3 1 317 200 (nearly 90%) were ≥65 years of age, representing nearly 5% of the population aged ≥65 years. More than 70% of these were women, and nearly half were ≥85 years old.…”

Section: Epidemiology Of Hf In Snfsmentioning

confidence: 99%

“…2 Similarly, in a 10% random sampling of 1840 SNFs during 2003 to 2004, 37.4% of the 500 322 SNF residents had HF. 17 Their mean age was 81 years, and twothirds were women; 11% were black, 3% were Hispanic, and 1% were Asian. Comorbidities were common, with chronic obstructive lung disease, diabetes mellitus, cerebrovascular disease, and peripheral artery disease each present in >30% of patients.…”

Section: Epidemiology Of Hf In Snfsmentioning

confidence: 99%

Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age.1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of community-dwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. [4][5][6] Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death.11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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“…Length of stay (LOS) and number of ED visits have been shown to provide additional information regarding re-admission. A significant proportion of patients are discharged to SNFs (Hutt, Elder, Fish, & Min, 2011). In a retrospective study of more than 10,000 patients admitted with HF, 30% were discharged to SNFs (Hutt et al, 2011).…”

mentioning

confidence: 99%

“…A significant proportion of patients are discharged to SNFs (Hutt, Elder, Fish, & Min, 2011). In a retrospective study of more than 10,000 patients admitted with HF, 30% were discharged to SNFs (Hutt et al, 2011). This may be in an attempt to decrease length of stay in the hospital.…”

mentioning

confidence: 99%

Factors Associated With Heart Failure Readmissions From Skilled Nursing Facilities

Akande¹

2017

IJCH

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Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge. Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days. Methods: A retrospective electronic chart review was completed on patients >65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p<0.10) were included for a multivariate logistic regression model. A receiver operating characteristic (ROC) curve was constructed to look at the final model's ability to predict the outcome. A numerical measure of the accuracy of the model was obtained from the area under the curve (AUC), where an area of 1.0 signifies near perfect accuracy. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p<0.05 level of significance. Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p<0.0087) and ADLs (p<0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine is associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs are over 9 times more likely to be readmitted within 30 days (OR=9.25) as compared to patients who are independent.

show abstract

Regional Variation in Mortality and Subsequent Hospitalization of Nursing Residents With Heart Failure

Cited by 19 publications

References 25 publications

Factors associated with heart failure readmissions from skilled nursing facilities

Factors associated with heart failure readmissions from skilled nursing facilities

Heart Failure Management in Skilled Nursing Facilities

Factors Associated With Heart Failure Readmissions From Skilled Nursing Facilities

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