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Many patients are discharged to a skilled nursing facility (SNF) after hospitalization for heart failure (HF) or acute myocardial infarction (AMI). Yet relatively little is known about the long term outcomes of these patients, including whether outcomes vary by state rates of discharge to a SNF. Characterization of this relationship can clarify the long-term prognosis of these patients and whether states with higher rates of discharge to a SNF have lower mortality among these patients, thereby suggesting the selection of healthier patients.
We used Medicare Standard Analytic, Denominator, and Chronic Condition Data Warehouse files to identify all HF and AMI hospitalizations and subsequent discharges to SNFs in 2008-09. We excluded patients who were aged <65, transferred out, discharged against medical advice, or who died during hospitalization. SNF discharges required a SNF claim on the same day or next day after discharge. State-level SNF discharge rates were calculated using all survivors of hospitalization. State-level 1-year mortality rates were calculated for patients discharged to a SNF. We characterized the relationship between state discharge rates to a SNF and 1-year mortality rates by Pearson correlation (r) and linear regression.
After HF hospitalization, state discharge rates to a SNF ranged from 12.0% to 36.9%, and 1-year mortality rates among patients discharged to a SNF ranged from 45.3% to 59.3%. No relationship was found between rates of SNF discharge and mortality (r=0.08; β=0.03; p=0.59). After AMI hospitalization, state discharge rates to a SNF ranged from 9.4% to 34.9%, and 1-year mortality rates among patients discharged to a SNF ranged from 35.8% to 51.6%. Rates of 1-year mortality among AMI patients discharged to a SNF decreased by only 2.3% per 10% increase in state discharge rate to a SNF (r=-0.36; β=-0.23; p=0.01).
1-year mortality is extremely high in HF and AMI patients discharged to a SNF regardless of highly variable rates of SNF discharge across states. There is no evidence that states with high SNF discharge rates are selecting low risk patients. Whether there is an advantage to higher SNF discharge rates is not yet known.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: AMI and PCI
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1158-101
- 2013 American College of Cardiology Foundation