University of Massachusetts Medical School Faculty Publications


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

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Geriatrics


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 beta-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.


Cross-sectional study, Heart failure with preserved ejection fraction, Heart failure with reduced ejection fraction, Skilled nursing facility

DOI of Published Version



J Cardiol. 2017 Oct 27. pii: S0914-5087(17)30254-X. doi: 10.1016/j.jjcc.2017.09.008. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal of cardiology

PubMed ID