Cardiac Skilled Care Doesn't Mean Good Results

Elderly heart failure patients in skilled nursing facilities face risks

(RxWiki News) After leaving the hospital, many elderly patients with heart failure need skilled nursing care. This kind of care, however, does not mean that patients and their families will go back to a normal life. In fact, these patients often have a higher risk of death or returning to the hospital.

Elderly patients with heart failure face a higher risk of bad outcomes. Now, a new study shows that elderly patients with heart failure who leave the hospital to go to a skilled nursing facility often have other health complications. Compared to other heart failure patients, those who go to a skilled nursing facility are more likely to die or return to the hospital within one year.

dailyRx Insight: Elderly heart patients at skilled nursing facilities are at risk

These findings do not necessarily mean that patients receive poor care at these facilities. In fact, Larry A. Allen, M.D., M.H.S., assistant professor of cardiology at the University of Colorado, notes that there is not a lot of information about the quality of care given at skilled nursing facilities. More research is needed, Allen adds, "to better understand this unique group of patients and the care they receive."

For their study, Allen and colleagues looked at data from nearly 15,500 Medicare patients who were discharged from the hospital after receiving at least three days of treatment for heart failure. Thirty days after leaving the hospital, 14 percent of patients who went to a skilled nursing facility had died, compared to only 4 percent of patients who went home after being discharged. After one year, 54 percent of skilled nursing home patients had died, compared to 29 percent of patients who returned home.

Thirty days after leaving the hospital, 27 percent of skilled nursing home patients were rehospitalized, compared to 24 percent of patients who returned home. After one year, rates of rehospitalization were more or less the same between skilled nursing care patients and at-home patients (76 percent versus 72 percent).

Heart disease (coronary artery disease, CAD) is the leading cause of death in the United States. CAD is primarily results from diet and habits, with the greatest risk factors coming from smoking, high blood pressure, high cholesterol, and diabetes. Genetics and family history also play a large part. The primary symptom of angina, commonly known as chest pain, occurs when the artery is almost completely blocked. Plaques made up of cholesterol and fibrous tissue lodge in the walls of the arteries that supply blood to the heart and restrict blood flow to the heart muscle. Complete closure or rupture of the plaque can cause a myocardial infarction, commonly known as a heart attack. Preventive surgical treatment is common, either by angioplasty and coronary stents (widening a blocked artery) or coronary artery bypass grafting (surgically replacing a damaged coronary artery with another one from the body).Management consists of a host of different medications for high blood pressure (diuretics, beta-blockers, ACE inhibitors), and cholesterol control (statins like Lipitor, Crestor) as well as secondary measures such as daily aspirin, anti-platelet medication (Plavix), and exercise.

The study is published in Circulation: Heart Failure, a journal of the American Heart Association.

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Review Date: 
March 30, 2011