Abstract
Objective
Skilled nursing facilities (SNFs) are common destinations after hospitalization for
patients with heart failure (HF). Our objective was to determine if patients in SNFs
with a primary hospital discharge diagnosis of HF benefit from an HF disease management
program (HF-DMP).
Design
This is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized
controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis.
The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures
and was delivered by an HF nurse advocate.
Setting and Participants
Patients with a primary hospital discharge diagnosis of HF discharged to SNF.
Methods
Composite outcome of all-cause hospitalization, emergency department visits, and mortality
were evaluated at 30 and 60 days post SNF admission. Linear mixed models accounted
for patient clustering at the physician level.
Results
Of 671 individuals enrolled in the main study, 125 had a primary hospital discharge
diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10 years, 53% women,
and mean ejection fraction 46% ± 15%. At 60 days post SNF admission, the rate of the
composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%)
(P = .02). The rate of the composite outcome at 30 days for the HF-DMP group was 18%
vs 31% in the usual care group (P = .11).
Conclusions and Implications
Patients with a primary hospital discharge diagnosis of HF who received HF-DMP while
cared for in an SNF had lower rates of the composite outcome at 60 days. Standardized
HF management during SNF stays may be important for patients with a primary discharge
diagnosis of HF.
Keywords
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Article info
Publication history
Published online: August 31, 2021
Footnotes
This project is made possible through grant from the National Heart, Lung, and Blood Institute, National Institutes of Health, NIH 5R01HL113387-02. H.W. is supported through K23HL145110. The National Institutes of Health had no role in design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
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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