Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure.
Himali Weerahandi, Erin L Chaussee, John A Dodson and 2 others
PMID 34478693WHAT IT FOUND
In skilled nursing facilities, a nurse-led heart failure program reduced 60-day hospitalization, emergency visits, or death in patients admitted primarily for heart failure.
The intervention lowered mortality to zero compared to 14.7% in usual care. This was a small subgroup analysis.
Key findings
01The composite rate of rehospitalization, ED visits, and mortality at 60 days was significantly lower in the intervention group (30%) compared to usual care (52%).
0260-day mortality was significantly lower in the intervention group (0%) compared to usual care (14.7%).
03Adherence to medication titration recommendations made by the nurse advocate was low, with only 24% followed by clinicians.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a post-hoc subgroup analysis, not the primary outcome of the larger trial, which was null. The sample size was small (125 patients), making the results susceptible to chance. The intervention was multifaceted, so it is unclear which specific component (e.g., education vs. monitoring) drove the benefit. Low adherence to medication recommendations suggests the observed benefit may not be due to pharmacological optimization alone.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume this intervention works for all heart failure patients in skilled nursing facilities. The benefit was only seen in the specific subgroup with a primary hospital diagnosis of heart failure, and the parent trial showed no significant difference in the composite outcome for the broader population.