Quality of Care of Nursing Home Residents Hospitalized With Heart Failure


  • Ali Ahmed MD, MPH, FACP,

    1. Divisions of
    2. Epidemiology and International Health and
    3. Center for Aging,
    4. Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Alabama;
    5. Heart Failure Clinic,
    6. Section of Geriatrics, and
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  • Michael T. Weaver RN, PhD, FAAN,

    1. Preventive Medicine, Department of Medicine, Departments of
    2. Biostatistics, School of Public Health,
    3. Graduate Studies, School of Nursing,
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  • Richard M. Allman MD,

    1. Divisions of
    2. Center for Aging,
    3. Heart Failure Clinic,
    4. Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Birmingham, Alabama;
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  • James F. DeLong MD, FACP,

    1. Heart Failure Clinic,
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  • Wilbert S. Aronow MD, FACC,

  • Cmd

    1. Section of Geriatrics, and
    2. Mount Sinai School of Medicine, New York, New York.
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  • An abstract based on the preliminary findings of this study was presented at the 2000 Annual Scientific Meeting of the Gerontological Society of America in Washington, DC, November 2000.

  • The analyses upon which this publication is based were performed under Contract Number 500–96-P60, entitled “Utilization and Quality Control Peer Review Organization for the State of Alabama,” sponsored by the Center for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Service, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

  • The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Center for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

Address correspondence to Ali Ahmed, MD, 1530 3rd Ave South, CH-19, Ste-219, Birmingham AL 35294-2041. E-mail: aahmed@uab.edu


OBJECTIVES: To determine whether the quality of heart failure (HF) care of hospitalized nursing home (NH) residents is different from that of patients admitted from other locations.

DESIGN: Retrospective chart review.

SETTING: Nursing home residents discharged from hospitals.

PARTICIPANTS: Medicare beneficiaries aged 65 and older.

MEASUREMENTS: Subjects were discharged with a primary discharge diagnosis of HF in Alabama in 1994. They were categorized as having been admitted from a NH or other locations. Bivariate logistic regression analysis was used to estimate crude odds ratios (ORs) and 95% confidence intervals (CIs) for left ventricular function (LVF) evaluation and angiotensin-converting enzyme (ACE) inhibitor use for NH residents relative to nonresidents. Multivariate generalized linear models were developed to determine independence of associations.

RESULTS: Subjects (N = 1,067 years) had a mean age ± standard deviation of 79 ± 7.4, 60% were female, and 18% were African Americans. Fewer NH residents (n = 95) received LVF evaluation (39% vs 60%, P < .001) and ACE inhibitors (50% vs 72%, P = .111). NH residents had lower odds for LVF evaluation (OR = 0.42, 95% CI = 0.27–0.64). The odds for ACE inhibitor use, although of similar magnitude, did not reach statistical significance (OR = 0.40, 95% CI = 0.12–1.28). After adjustment of patient and care characteristics, admission from a NH was significantly associated with lower LVF evaluation (adjusted OR = 0.64, 95% CI = 0.49–0.82) but not with ACE inhibitor use (adjusted OR = 0.59, 95% CI = 0.16–2.14).

CONCLUSIONS: Quality of HF care received by hospitalized NH residents was lower than that received by others. Further studies are needed to determine reasons for the lack of appropriate evaluation and treatment of NH patients with HF who are admitted to hospitals.