Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study

Sheila M. Manemann, Alanna Chamberlain, Cynthia M. Boyd, Susan A. Weston, Jill Killian, Cynthia L. Leibson, Andrea L Cheville, Jennifer St. Sauver, Shannon M Dunlay, Ruoxiang Jiang, Veronique Lee Roger

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Abstract

Objectives 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. Patients and 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)490-499
Number of pages10
JournalMayo Clinic Proceedings
Volume92
Issue number4
DOIs
StatePublished - Apr 1 2017

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Skilled Nursing Facilities
Hospitalization
Heart Failure
Activities of Daily Living
Centers for Medicare and Medicaid Services (U.S.)
Chronic Renal Insufficiency

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Skilled Nursing Facility Use and Hospitalizations in Heart Failure : A Community Linkage Study. / Manemann, Sheila M.; Chamberlain, Alanna; Boyd, Cynthia M.; Weston, Susan A.; Killian, Jill; Leibson, Cynthia L.; Cheville, Andrea L; St. Sauver, Jennifer; Dunlay, Shannon M; Jiang, Ruoxiang; Roger, Veronique Lee.

In: Mayo Clinic Proceedings, Vol. 92, No. 4, 01.04.2017, p. 490-499.

Research output: Contribution to journalArticle

Manemann, Sheila M. ; Chamberlain, Alanna ; Boyd, Cynthia M. ; Weston, Susan A. ; Killian, Jill ; Leibson, Cynthia L. ; Cheville, Andrea L ; St. Sauver, Jennifer ; Dunlay, Shannon M ; Jiang, Ruoxiang ; Roger, Veronique Lee. / Skilled Nursing Facility Use and Hospitalizations in Heart Failure : A Community Linkage Study. In: Mayo Clinic Proceedings. 2017 ; Vol. 92, No. 4. pp. 490-499.
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title = "Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study",
abstract = "Objectives 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. Patients and 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. Conclusion 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.",
author = "Manemann, {Sheila M.} and Alanna Chamberlain and Boyd, {Cynthia M.} and Weston, {Susan A.} and Jill Killian and Leibson, {Cynthia L.} and Cheville, {Andrea L} and {St. Sauver}, Jennifer and Dunlay, {Shannon M} and Ruoxiang Jiang and Roger, {Veronique Lee}",
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T1 - Skilled Nursing Facility Use and Hospitalizations in Heart Failure

T2 - A Community Linkage Study

AU - Manemann, Sheila M.

AU - Chamberlain, Alanna

AU - Boyd, Cynthia M.

AU - Weston, Susan A.

AU - Killian, Jill

AU - Leibson, Cynthia L.

AU - Cheville, Andrea L

AU - St. Sauver, Jennifer

AU - Dunlay, Shannon M

AU - Jiang, Ruoxiang

AU - Roger, Veronique Lee

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Objectives 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. Patients and 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. Conclusion 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.

AB - Objectives 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. Patients and 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. Conclusion 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.

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