Elsevier

Heart & Lung

Volume 41, Issue 2, March–April 2012, Pages 115-124
Heart & Lung

Care of Patients with Cardiovascular Disorders
Cardiac rehabilitation in skilled nursing facilities: A missed opportunity

https://doi.org/10.1016/j.hrtlng.2011.08.006Get rights and content

Abstract

Background

After hospitalization for a cardiac event, older adults are frequently discharged to a skilled nursing facility (SNF) for postacute care. The American Association of Cardiopulmonary Rehabilitation recommends that cardiac care be integrated into procedures at SNFs.

Objective

We undertook this research to describe the characteristics of patients in SNFs after a cardiac event and the cardiac care delivered at SNFs.

Methods

A dual approach included (1) a retrospective medical record review of consecutive patients admitted to 2 hospital-based SNFs after a cardiac event (n = 80), and (2) surveys from healthcare professionals (n = 21) working in these facilities.

Results

Thirty-two percent of patients were not candidates for cardiac rehabilitative interventions because they had been rehospitalized, discharged to long-term care facilities, or manifested contraindications to exercise. No standard assessment of exercise tolerance was evident, and although 70% of patients were discharged home, cardiac-specific discharge education was seldom evident. Healthcare professionals in SNFs reported that standard procedures for cardiac care services were lacking.

Conclusion

The integration of cardiac care into SNFs is important to ensure the safety of therapy and improve the transition of patients from SNFs to outpatient cardiac rehabilitation programs.

Section snippets

Methods

This exploratory study used a retrospective and cross-sectional design. In Phase 1, we examined the medical records of patients admitted to 1 of 2 large tertiary hospital-based SNFs. In Phase 2, a questionnaire was completed by healthcare professionals working in these facilities, to validate the results of the medical record review. Both phases of the study (the medical record review and staff questionnaires) were approved by the institutional review boards of each hospital-based SNF. Staff

Characteristics of Patients in SNFs After a Cardiac Event

The demographics of the sample are listed in Table 1. The mean age was 77.5 years (range, 65 to 95 years), 78% were female, 43% were black, and the majority had heart failure. The mean length of stay in the SNF was 12 days (Standard Deviation = 10 days). When patients were discharged from the SNF, 70% went home, 16% were readmitted to acute hospital care, and 14% went to a nursing home.

Patient characteristics are listed in Table 1. Overall, 19 participants (21%) had 1 or more cardiac disorders

Discussion

Neither of the 2 AACVPR recommended Phase IB postacute cardiac care rehabilitative components (exercise and education) were integrated into SNF practice in a structured or consistent manner. Not providing these cardiac-specific care interventions is a missed opportunity for ensuring that cardiac patients receive complete and safe rehabilitation, focusing on their chronic disease during SNF transitional care.

Monitoring exercise tolerance is an essential component to ensure that the patient's

Acknowledgments

This study was supported by Multidisciplinary Clinical Research Training Program Grant K12RR023264, and was made possible by grant KL2RR024990 from the National Center for Research Resources (a component of the National Institutes of Health) and the National Institutes of Health Roadmap for Medical Research. Its contents are solely the responsibility of the authors, and do not necessarily represent the official views of the National Center for Research Resources or National Institutes of

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