Discharge to Skilled Nursing Facilities Linked to Death

Death and rehospitalization rates high in heart failure patients discharged to these facilities

WEDNESDAY, March 30 (HealthDay News) -- Patients with heart failure discharged to skilled nursing facilities (SNFs) have an increased risk for rehospitalization and death, according to a study published online March 29 in Circulation: Heart Failure.

Larry A. Allen, M.D., from the University of Colorado Denver in Aurora, and colleagues analyzed data from 15,459 Medicare patients with heart failure, aged 65 years or older, who were discharged to SNF or home in 2005 and 2006 following three days or more of hospitalization. In total, 53.6 percent were discharged to home with self-care, 22.3 percent were discharged to home with health service, and 24.1 percent were discharged to SNF. All-cause mortality and rehospitalization at 30 days and one year following discharge were the main outcomes studied.

The investigators found that patients with advanced age, female gender, longer hospital stay, and other comorbidities used SNFs more, and had modestly lower performance measures. Patients discharged to SNF had higher unadjusted event rates for death and rehospitalization compared to those discharged to home at 30 days (14.4 versus 4.1 and 27.0 versus 23.5, respectively) and one year (53.5 versus 29.1 and 76.1 versus 72.2, respectively). The correlation between discharge to SNF and increased death and rehospitalization remained after adjusting for patient characteristics (hazard ratios, 1.76 and 1.08, respectively).

"Discharge to SNF occurs in approximately one in five Medicare beneficiaries following hospitalization for heart failure," the authors write. "Patients discharged to SNF face a very high risk for death or rehospitalization. These results highlight the need to evaluate care processes and outcomes in the SNF setting."

Several study authors disclosed financial relationships with the pharmaceutical industry.

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