Abstract
Objective
Patients discharged from the hospital to a skilled nursing facility (SNF) are not
typically part of a heart failure disease management program (HF-DMP). The objective
of this study is to determine if an HF-DMP in SNF improves outcomes for patients with
HF.
Design
Cluster-randomized controlled trial.
Participants
The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342
to usual care).
Methods
The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication
optimization, education, and 7-day visit post SNF discharge. The composite outcome
was all-cause hospitalization, emergency department visits, or mortality at 60 days.
Secondary outcomes included the composite endpoint at 30 days, change in the Kansas
City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60 days. Rehospitalization
and mortality rates were calculated as an exploratory outcome.
Results
Mean age of the patients was 79 ± 10 years, 58% were women, and the mean ejection
fraction was 51% ± 16%. At 30 and 60 days post SNF admission, the composite endpoint
was not significant between DMP (29%) and usual care (32%) at 30 days and 60 days
(43% vs 47%, respectively). The Kansas City Cardiomyopathy Questionnaire significantly
improved in the HF-DMP vs usual care for the Physical Limitation (11.3 ± 2.9 vs 20.8
± 3.6; P = .039) and Social Limitation subscales (6.0 ± 3.1 vs 17.9 ± 3.8; P = .016). Self-care of HF Index was not significant. The total number of events (composite
endpoint) totaled 517 (231 in HF-DMP and 286 in usual care). Differences in the 60-day
hospitalization rate [mean HF-DMP rate 0.43 (SE 0.03) vs usual care 0.54 (SE 0.05),
P = .04] and mortality rate (HF-DMP 5.2% vs usual care 10.8%, P < .001) were significant.
Conclusions and Implications
The composite endpoint was high for patients with HF in SNF regardless of group. Rehospitalization
and mortality rates were reduced by the HF-DMP. HF-DMPs in SNFs may be beneficial
to the outcomes of patients with HF. SNFs should consider structured HF-DMPs for their
patients.
Keywords
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Article info
Publication history
Published online: June 16, 2021
Footnotes
This study was funded by a National Heart, Lung, and Blood Institute grant (no. R01 HL 113387).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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