Stays in skilled nursing facilities can mean bad news for heart failure patients

New research from Mayo Clinic found that skilled nursing facilities, where heart patients go after a hospital stay and before they head home, may not be as effective in preventing hospital readmission as providers once thought.

The study, published in Mayo Clinic Proceedings, sought to examine the likelihood that heart failure patients would readmitted to a hospital after spending time in a nursing facility.

"We really wanted to understand the complete experience of heart failure patients," said Sheila Manemann, the lead author on the study and a healthcare delivery researcher at Mayo Clinic, in a statement. "To do so, we needed to look at not just outpatient and hospital information, but that from skilled nursing facilities. This required linked data from across the community and across the lives of these patients."

Investigators studied medical records of more than 1,400 patients diagnosed with heart failure who were residents in Olmsted Country, Minnesota, between January 2000 and December 2010. Records were obtained from the Rochester Epidemiology Project and CMS.

After adjusting for other risk factors and conditions, the researchers found that being in a skilled nursing facility meant a heart failure patient is 50 percent more likely to return to the hospital compared to patients who immediately went home after being discharged from the hospital.

Data showed that more than 40 percent of heart failure patients were admitted to a skilled nursing facility at some point after they were diagnosed, and 37 percent of those discharged from a facility returned to one at least two more times. Additionally, hospital readmissions for patients who had been at a nursing facility were for reasons unrelated to their cardiovascular health.

"We wanted to try to identify ways to improve outcomes for patients released to a skilled nursing facility, as well as potentially for patients overall," said Véronique Roger, MD, an author on the study and a cardiologist at Mayo Clinic, in a statement. “The level of activity a patient has when he or she enters a skilled nursing facility is an important predictor of whether he or she will be readmitted to the hospital and how [he or she] will do in the long term.”

Roger said more programs should be implemented to help heart failure patients remain active and mobile, even while in nursing facilities.

"We want to make it much more common that heart failure patients who transition to a skilled nursing facility are able to return home," she said. "Most importantly, we'd like to see healthier individuals able to consistently participate in life activities."