Readmission Common for HF Patients Discharged to Nursing Facilities

This article about heart failure readmission, on Medscape Cardiology, caught my eye:

http://www.medscape.com/viewarticle/878487

(free registration required to view).

It summarizes a recent paper from the Mayo Clinic Proceedings (Manemann SM, Chamberlain AM, Boyd CM, et al. Skilled nursing facility use and hospitalizations in heart failure: A community linkage study. Mayo Clin Proc 2017; 92:490–499. )  The paper used Medicare claims to show that patients admitted with heart failure and discharged to a nursing facility (e.g. nursing home) were 50% more likely to be readmitted to hospital, than those that were well enough to be discharged home.  These patients suffered a cycle of redmission after readmission.  The study also showed that physical activity was tremendously important in enabling patients to care for themselves and perform as much of their self-care as possible, potentially breaking this cycle.

I do not think this paper is meant as a criticism of nursing home care.  There are barriers in some care homes, such as being able to adjust diet to minimize salt intake (this is very important for heart failure patients but can be hard when you have to cook for a lot of people).  Most homes and facilities are doing the best they can.  Patients who are discharged to these facilities are usually frail, with other complex medical problems.  Thus, they are more likely to be readmitted than patients who were well enough to be discharged home.  When one medical problem decompensates, it throws the rest of them out of balance too, thus leading to another readmission.

It is precisely this cycle of admission and readmission that we are aiming to break with our multidisciplinary heart function clinic. This model is proven to reduce hospitalizations and make patients feel better, faster, and live longer.  We are partnering with family physicians, our community home follow up nurse colleague Jen, other community nursing colleagues, and reaching out to local long term care facilities to improve care, reduce heart failure readmission, and change this pattern for the better.