Heart failure management in skilled nursing facilities: A scientific statement from the American Heart Association and the Heart Failure Society of America

Corrine Y. Jurgens, Sarah Goodlin, Mary Dolansky, Ali Ahmed, Gregg C. Fonarow, Rebecca Boxer, Ross Arena, Lenore Blank, Harleah G. Buck, Kerry Cranmer, Jerome L. Fleg, Rachel J. Lampert, Terry A. Lennie, Joann Lindenfeld, Ileana L. Piña, Todd P. Semla, Patricia Trebbien, Michael W. Rich

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Heart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age. 1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3 Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities. Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of communitydwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. 4-6 Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8 SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death. 11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patient-centered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting.

Original languageEnglish
Pages (from-to)263-299
Number of pages37
JournalJournal of cardiac failure
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2015

Keywords

  • AHA Scientific Statements
  • exercise
  • heart failure
  • hospital discharge
  • palliative medicine
  • rehabilitation
  • skilled nursing facility

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    Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., Arena, R., Blank, L., Buck, H. G., Cranmer, K., Fleg, J. L., Lampert, R. J., Lennie, T. A., Lindenfeld, J., Piña, I. L., Semla, T. P., Trebbien, P., & Rich, M. W. (2015). Heart failure management in skilled nursing facilities: A scientific statement from the American Heart Association and the Heart Failure Society of America. Journal of cardiac failure, 21(4), 263-299. https://doi.org/10.1016/j.cardfail.2015.02.007