Heart failure patients in skilled nursing facilities: evidence needed.

The observational study by Allen and colleagues1 in this issue of Circulation: Heart Failure reports disturbing results about adverse outcomes for vulnerable patients with heart failure (HF) who are discharged from hospitals to skilled nursing facilities (SNFs). Data collected as part of the Get With the Guidelines-HF program were linked with claims files from the Centers for Medicare & Medicaid Services to compare characteristics and rates of 30-day and 1-year all-cause mortality and rehospitalization among hospitalized patients with HF discharged to home and SNFs. Nearly one fourth (24.1%), or 3727 of the 15459 patients with HF in the sample, were discharged to SNFs. Longer length of hospital stay, older age, history of depression or stroke, and female sex were characteristics most associated with discharge to an SNF. Compared with patients discharged to home, patients discharged to SNFs had significantly higher mortality rates. At 1 year postdischarge, patients discharged to SNFs had an alarming 53.5% mortality rate compared with 29.1% for patients discharged to home (P 0.0001). Moreover, after adjusting for characteristics associated with negative outcomes, patients discharged to SNFs had an estimated 76% increased risk of death. The investigators recommend that longitudinal studies be conducted to characterize the patients discharged to SNFs, to understand the processes of care received, and to determine whether a different set of performance measures are needed for patients discharged to SNFs rather than to home.