Heart Failure Patients in Skilled Nursing Facilities

Pressler, Susan J.

doi:10.1161/circheartfailure.111.962258

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…250,251 Efforts to monitor and improve the quality of HF care in SNFs will need to take into account the complexity of care, multiple comorbid conditions, social isolation, low health literacy, cognitive impairment, resource limitations, and patient preferences regarding goals of care. 27,94,252 HF disease management programs and systems of care may improve care in the SNF setting 7,26,27,94,252 and may reduce the frequency of hospitalization and improve quality of life and functional status in outpatients. 7,250,251,253 Disease management for HF spans all settings in which the HF patient may be encountered and emphasizes care coordination and enhanced care transitions.…”

Section: Quality Improvement Methodsmentioning

confidence: 99%

“…Modification of existing measures and new quality measures specifically targeted for SNF residents will likely be required to improve care and outcomes for this high-risk patient population. 94 Ideally, a set of quality measures for patients with HF in a SNF will include both measures of processes known to influence desirable outcomes for this patient population and measures of outcomes themselves. Desired outcomes for HF patients may include improved survival, reduced hospitalization, reduced readmission rates, reduced clinical deterioration, fewer symptoms of HF, improved activity level, improved by guest on http://circheartfailure.ahajournals.org/ Downloaded from patient self-management, and maintenance or improvement in level of independence.…”

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

“…Desired outcomes for HF patients may include improved survival, reduced hospitalization, reduced readmission rates, reduced clinical deterioration, fewer symptoms of HF, improved activity level, improved by guest on http://circheartfailure.ahajournals.org/ Downloaded from patient self-management, and maintenance or improvement in level of independence. 94,233,236 However, for some HF patients in SNFs, palliation of symptoms and comfort care are the most desirable outcomes.…”

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

“…94,233,238 The hospitalization episode before discharge to a SNF provides an opportunity to improve care coordination and determine the therapeutic interventions that patients will need while residing in a SNF. 94 Determining the number and types of individualized interventions necessary while a patient resides at a SNF requires a comprehensive assessment of a patient's physical, cognitive, emotional, and social status before hospital discharge. 94,238 Prior studies have suggested that HF patients require a large number of individualized nursing interventions during hospitalization.…”

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

“…94 Determining the number and types of individualized interventions necessary while a patient resides at a SNF requires a comprehensive assessment of a patient's physical, cognitive, emotional, and social status before hospital discharge. 94,238 Prior studies have suggested that HF patients require a large number of individualized nursing interventions during hospitalization. The number and types of nursing interventions needed by patients with HF residing in a SNF continue to be high and complex.…”

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

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Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart 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. 2,3Despite 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 community-dwelling 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][5][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. 8SNF 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 patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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Section: Quality Improvement Methodsmentioning

confidence: 99%

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

Section: Quality Outcomes Quality Measures and The Application Of Meamentioning

confidence: 99%

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Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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Nurses as educators in the comprehensive heart failure care programme—Are we ready for it?

Krówczyńska

Jankowska‐Polańska

2020

Nursing Open

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Aim To assess education frequency and nurses' comfort when educating patients hospitalized in different hospital units to prepare them for self‐care. Design A cross‐sectional survey. The study included nurses working in units where HF patients were hospitalized. Results The average score for comfort of education was 5.43 (between “slightly comfortable” and “very comfortable”). The most comfortable topics were “Daily weight monitoring” (5.81 ± 1.25), “Signs/symptoms of worsening condition” (5.77 ± 1.19) and “Fluid restriction” (5.76 ± 1.23). The respondents felt least comfortable when teaching about “Medications” (5.06 ± 1.35) and “Low‐sodium diet” (5.31 ± 1.42). The mean score obtained for education frequency was 5.21 ( SD 2.51). The nurses most frequently educated their patients on such topics as “Daily weight monitoring” (5.82), “Signs/symptoms of worsening condition” (5.9) and “Fluid restriction” (5.92). Conclusions Polish nurses are not ready to perform comprehensive HF care tasks without preparation.

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