AMDA's 2019 Annual Conference

FR15 - Beyond the Basics of Heart Failure Management in SNFs: Incorporating Patient-Centered Goals of Care, Cardiac Rehabilitation, and Telemedicine to Optimize Care

Mar 8, 2019 1:30pm ‐ Mar 8, 2019 3:00pm


This session will discuss medical and supplemental interventions that may be utilized to enhance the care of geriatric cardiac patients admitted to skilled nursing facilities (SNFs) beyond the traditional standards of care. Practitioners and administrators will gain an understanding of the pitfalls of traditional heart failure management strategies for this complex older population, and the importance of addressing co-morbid illness in the context of patient-centered, goal- based cardiac care via cased-based examples. Presenters will discuss the utility, logistics, and potential significant clinical benefit of integrating evidenced-based recommendations for cardiac rehabilitation within the post-acute/sub-acute rehabilitation stay for cardiac patients, as a supplement to the restorative physical therapy traditionally offered. Finally, they will review and discuss the implications, logistics, and potential clinical impact of broadening the scope of telehealth within the SNF sector, including the potential role of virtual visits with cardiologists/heart failure (HF) specialists for patients with heart disease.

Learning Objectives: 

  • Explain the medical complexity and vulnerability to poor outcomes of patients with cardiovascular disease residing in/discharged to skilled nursing facilities after hospital discharge, and the factors associated with hospital readmission.
  • Develop an effective medical management plan for older SNF HF patients within the context of expressed goals of care, and anticipated discharge status and with consideration of confounding and competing co-morbidities.
  • Discern the components of cardiac rehabilitation (CR), and the evidence supporting and practical considerations for incorporating CR into the management of cardiac conditions especially prevalent and modifiable among patients in post-acute care.
  • Describe the available telemedicine technologies, and understand the indications, benefits, practical considerations, and challenges of implementing a telehealth program to facilitate specialty-based management of cardiovascular disease in SNFs.


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