title: Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study.
abstract: OBJECTIVE
  To examine the effect of skilled nursing facility (SNF) use on hospitalizations in patients with heart failure (HF) and to examine predictors of hospitalization in patients with HF admitted to a SNF.
  
  
  METHODS
  Olmsted County, Minnesota, residents with first-ever HF from January 1, 2000, through December 31, 2010, were identified, and clinical data were linked to SNF utilization data from the Centers for Medicare and Medicaid Services. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization.
  
  
  RESULTS
  Of 1498 patients with incident HF (mean ± SD age, 75±14 years; 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median follow-up, 3.6 years; range, 0-13.0 years). Of those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction, and comorbidities, SNF use was associated with a 50% increased risk of hospitalization compared with no SNF use (adjusted hazard ratio, 1.52; 95% CI, 1.31-1.76). In SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living requiring assistance were independently associated with an increased risk of hospitalization.
  
  
  CONCLUSIONS
  Approximately 40% of patients with HF were admitted to a SNF at some point after diagnosis. Compared with SNF nonusers, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization in SNF users were mostly noncardiovascular, including reduced ability to perform activities of daily living. These findings underscore the effect of physical functioning on hospitalizations in patients with HF in SNFs and the importance of strategies to improve physical functioning.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Manemann
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Jill
authors.initials: J
authors.lastname: Killian
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.affiliation: Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cheville
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer
authors.initials: J
authors.lastname: St Sauver
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Ruoxiang
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: roger.veronique@mayo.edu.
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger