Who are they? Patients with heart failure in American skilled nursing facilities

J Cardiol. 2018 Apr;71(4):428-434. doi: 10.1016/j.jjcc.2017.09.008. Epub 2017 Oct 28.


Background: Heart failure (HF) is common among skilled nursing facility (SNF) residents, yet patients with HF in the SNF setting have not been well described.

Methods: Using Minimum Data Set 3.0 cross-linked to Medicare data (2011-2012), we studied 150,959 HF patients admitted to 13,858 SNFs throughout the USA. ICD-9 codes were used to differentiate patients with HF with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or unspecified HF.

Results: The median age of the study population was 82 years, 68% were women, 34% had HFpEF, and 27% had HFrEF. HFpEF patients were older than those with HFrEF. Moderate/severe physical limitations (82%) and cognitive impairment (37%) were common, regardless of HF type. The burden and pattern of common comorbidities, with the exception of coronary heart disease, were similar among all groups, with a median of five comorbidities. One half of patients with HF had been prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 39% evidence-based β-blockers.

Conclusions: SNF residents with HF are old and suffer from significant physical limitations and cognitive impairment and a high degree of comorbidity. These patients differ substantially from HF patients enrolled in randomized clinical trials and that might explain divergence from treatment guidelines.

Keywords: Cross-sectional study; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Skilled nursing facility.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Comorbidity
  • Female
  • Heart Failure / epidemiology*
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Hospitalization
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Skilled Nursing Facilities / statistics & numerical data*
  • United States / epidemiology
  • Ventricular Dysfunction, Left / complications


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors