Abstract 207: Quality Improvement Project: Urgent Heart Failure Clinic Reduces Admissions And Emergency Department Visits In Heart Failure Patients.

Abstract

Currently, 6 million Americans suffer from congestive heart failure (CHF). The economic burden of the disease continues to rise with an estimated cost of $70 billion by 2030. Providing high value care to CHF patients continues to be a challenge and a priority nationwide. We aim to evaluate the efficacy of the multicenter telemedicine Urgent Heart Failure Clinic (UHFC) in the reduction of hospital admission and emergency room visit rates and health care costs. UHFC care team consists of a primary cardiologist to review the patient’s overall care plan, care coordination by cardiology CHF nurse navigator, CHF nurse practitioners, community-based resources, and intensive medication management and monitoring. Enrolled patients are offered complex care coordination and frequent nursing follow up to reinforce compliance, provide education, and identify additional resources for patients. A retrospective chart review of patients deemed high-risk for heart failure readmission and enrolled into UHFC was conducted. Primary endpoint was the evaluation of admission and emergency room utilization 90-day prior and post enrollment in UHFC. Of the 132 patients enrolled: 80% (106 of 132) hypertensive, 71% (94 of 132) had hyperlipidemia, 55% (73 of 132) diabetic, 61% (81 of 132) had chronic renal disease, 54% (71 of 132) had coronary artery disease, 31% (41 of 132) had valvular disease, 22% (29 of 132) had pulmonary hypertension, and 60.6% (80 of 132) had arrhythmias. 44% (58 of 132) ejection fraction (EF) < 50% and 56% (74 of 132) EF ≥ 50%. There was a 47.2% (103 vs 195) reduction in hospitalizations and a 24% (19 vs 25) reduction in emergency room visits post enrollment. Prior to enrollment 79% (105 of 132) of patients had hospitalizations compared to the 54.5% (72 of 132) of patients that had hospitalizations post enrollment. An individual decrease in the number of admissions was seen in 56.8% (75 of 132) of patients post enrollment. Overall, 92 admissions were saved equating to a cost savings of $1,487,124.50. In conclusion, utilization of UHFC had a significant reduction in admission rates within 90-day post enrollment. Implementation successfully led to a decrease in hospital utilization and thus a substantial reduction in cost of care.