title: Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.
abstract: BACKGROUND
  Heart failure (HF) is the leading cause of hospitalization among older Americans. Subsequent discharge to skilled nursing facilities (SNF) is not well described.
  
  
  RESULTS
  We performed an observational analysis of Medicare beneficiaries ≥65 years of age, discharged alive to SNF or home after ≥3-day hospitalization for HF in 2005 and 2006 within the Get With The Guidelines-HF Program. Among 15 459 patients from 149 hospitals, 24.1% were discharged to an SNF, 22.3% to home with home health service, and 53.6% to home with self-care. SNF use varied significantly among hospitals (median, 10.2% versus 33.9% in low versus high tertiles), with rates highest in the Northeast. Patient factors associated with discharge to SNF included longer length of stay, advanced age, female sex, hypotension, higher ejection fraction, absence of ischemic heart disease, and a variety of comorbidities. Performance measures were modestly lower for patients discharged to SNF. Unadjusted absolute event rates were higher at 30 days (death, 14.4% versus 4.1%; rehospitalization, 27.0% versus 23.5%) and 1 year (death, 53.5% versus 29.1%; rehospitalization, 76.1% versus 72.2%) after discharge to SNF versus home, respectively (P<0.0001 for all). After adjustment for measured patient characteristics, discharge to SNF remained associated with increased death (hazard ratio, 1.76; 95% confidence interval, 1.66 to 1.87) and rehospitalization (hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14).
  
  
  CONCLUSIONS
  Discharge to SNF is common among Medicare patients hospitalized for HF, and these patients face substantial risk for adverse events, with more than half dead within 1 year. These findings highlight the need to better characterize this unique patient population and understand the SNF care they receive.
authors: Colorado Cardiovascular Outcomes Research Consortium, University of Colorado Denver, Aurora, USA. larry.allen@ucdenver.edu
authors: Larry A
authors: LA
authors: Allen
authors: Adrian F
authors: AF
authors: Hernandez
authors: Eric D
authors: ED
authors: Peterson
authors: Lesley H
authors: LH
authors: Curtis
authors: David
authors: D
authors: Dai
authors: Frederick A
authors: FA
authors: Masoudi
authors: Deepak L
authors: DL
authors: Bhatt
authors: Paul A
authors: PA
authors: Heidenreich
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D010359:Patient Readmission; D012042:Registries; D012111:Residence Characteristics; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States