Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.
Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.
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DOI：
10.1161/circheartfailure.110.959171
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发表时间：
2011-05
期刊：
影响因子：
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通讯作者：
Fonarow GC
中科院分区：
文献类型：
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作者：
Allen LA;Hernandez AF;Peterson ED;Curtis LH;Dai D;Masoudi FA;Bhatt DL;Heidenreich PA;Fonarow GC
心力衰竭（HF）是美国老年人住院的主要原因。随后出院到专业护理机构（SNF）的情况没有得到很好的描述。我们对2005年和2006年在指南-HF项目中≥65岁的医疗保险受益人进行了观察性分析，这些受益人在因HF住院≥3天后活着出院到SNF或家中。在来自149家医院的15459名患者中，24.1%的患者出院到SNF，22.3%的患者出院到家庭健康服务，53.6%的患者出院到家庭自我护理。SNF的使用在医院之间差异很大（中位数，低三分位数为10.2%，高三分位数为33.9%），东北部的使用率最高。与出院至SNF相关的患者因素包括住院时间较长、高龄、女性、低血压、射血分数较高、无缺血性心脏病以及各种合并症。出院至SNF的患者的性能指标略低。出院后30天（死亡，14.4%比4.1%;再住院，27.0%比23.5%）和1年（死亡，53.5%比29.1%;再住院，76.1%比72.2%）的未校正绝对事件发生率分别高于出院后回家（P均<0.0001）。在对测量的患者特征进行校正后，出院至SNF仍然与死亡（风险比，1.76; 95%置信区间，1.66至1.87）和再住院（风险比，1.08; 95%置信区间，1.03至1.14）增加相关。出院至SNF在因HF住院的医疗保险患者中很常见，这些患者面临不良事件的重大风险，超过一半的患者在1年内死亡。这些发现强调了需要更好地描述这一独特的患者人群，并了解他们接受的SNF护理。
Heart failure (HF) is the leading cause of hospitalization among older Americans. Subsequent discharge to skilled nursing facilities (SNF) is not well described. We performed an observational analysis of Medicare beneficiaries ≥65 years of age, discharged alive to SNF or home after ≥3-day hospitalization for HF in 2005 and 2006 within the Get With The Guidelines–HF Program. Among 15 459 patients from 149 hospitals, 24.1% were discharged to an SNF, 22.3% to home with home health service, and 53.6% to home with self-care. SNF use varied significantly among hospitals (median, 10.2% versus 33.9% in low versus high tertiles), with rates highest in the Northeast. Patient factors associated with discharge to SNF included longer length of stay, advanced age, female sex, hypotension, higher ejection fraction, absence of ischemic heart disease, and a variety of comorbidities. Performance measures were modestly lower for patients discharged to SNF. Unadjusted absolute event rates were higher at 30 days (death, 14.4% versus 4.1%; rehospitalization, 27.0% versus 23.5%) and 1 year (death, 53.5% versus 29.1%; rehospitalization, 76.1% versus 72.2%) after discharge to SNF versus home, respectively (P<0.0001 for all). After adjustment for measured patient characteristics, discharge to SNF remained associated with increased death (hazard ratio, 1.76; 95% confidence interval, 1.66 to 1.87) and rehospitalization (hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14). Discharge to SNF is common among Medicare patients hospitalized for HF, and these patients face substantial risk for adverse events, with more than half dead within 1 year. These findings highlight the need to better characterize this unique patient population and understand the SNF care they receive.