Heart Failure Management in Nursing Homes – Pilot Study

Objective: Heart failure (HF) is a leading cause of hospitalization among nursing home (NH) residents which confers significant morbidity and mortality risks and places an enormous economic burden on the health care system and society. The purpose of this study was to identify care patterns for NH residents with a HF diagnosis.

Methods: We sent surveys to Directors of Nursing (DON) at a nationally representative, random sample of 50 NHs. The survey was designed to learn about the use and frequency of evidence-based care activities provided for NH residents with a HF diagnosis. Surveys were mailed twice with the option of completing the survey online or return mail. Follow up phone calls to non-responders were made to provide an opportunity for DONs to complete the survey over the phone.

Results: Response rate reached 68%. NHs in the response group were not significantly different from the non-responders. Most frequently reported care activities performed daily for NH residents with HF were assessing changes in symptoms (94%), changes in mental status (91%), and evidence of swelling/edema (85%). Less frequent activities done daily were monitoring labs (15%), assessing fluid intake/output (48%) and measuring weight (15%). The frequency of all care activities varied across NHs from ‘daily' to ‘only when ordered'.

Conclusions: We found wide variation in care patterns for NH residents with a known diagnosis of HF. Based on our findings, not all evidence-based guidelines for HF care and monitoring were followed in the NH setting, which could affect hospitalization and other outcomes.