Abstract P030: Use of Skilled Nursing Facilities in Heart Failure: Role of Multimorbidity in the Community

Background: As the population ages, it has been reported that discharges to skilled nursing facilities (SNF) have increased. Yet, data on SNF utilization in HF are sparse and predictors are not well defined. Objectives: In a community cohort of incident hospitalized HF patients, we evaluated trends in use of SNF from 1987 through 2006 and described predictors of discharge to SNF. Methods: All Olmsted County, MN residents hospitalized with first ever (incident) HF (ICD-9 code 428) from 1987 through 2006 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Using logistic regression, we determined whether referral to SNF had increased over time and identified predictors of referral to SNF. Results: Among 952 patients (mean age 75±13, 47% male), 185 (19%) were referred to a SNF. After adjustment for age and sex, referral of HF patients to SNF did not change from 1987 to 2006 (p=0.849). Patients with a Charlson comorbidity index of 3 or higher were twice as likely to be referred to a SNF (odds ratio: 1.91, 95% CI: 1.36-2.69, adjusted for age and sex). Individual characteristics associated with referral to a SNF are tabulated. After adjustment, the strongest predictor was dementia, followed by older age, anemia, hypertension and diabetes. Conclusion: In the community, approximately one-fifth of hospitalized HF patients are referred to a SNF and this did not change from 1987 to 2006. While older age and cardiovascular-related factors (hypertension, diabetes) were associated with referral to SNF, non-cardiovascular factors (particularly dementia) were strong predictors of referral. These findings underscore the impact of multimorbidity on HF outcomes.