Abstract 221: Multiple Heart Failure Hospitalizations: Winning the War

Abstract

Background: The lifetime risk of developing Heart Failure (HF) is 20% for Americans ≥40 years of age. In the United States, greater than 650,000 new HF cases are diagnosed annually. HF prevalence is highest in the >65 years group. Importantly, 1 in 5 Americans will be >65 years of age by 2050. Additionally, HF has high absolute mortality rates of approximately 50% within 5 years of diagnosis. The total cost of HF care in the United States exceeds $30 billion annually. Prior studies acknowledged that more research is needed to identify processes that are clearly associated with reduced readmissions. Objective: The objective was to examine the practice of proactive monitoring and communication of body weights among HF patient and their Health providers; and investigate its relationship with rate of rehospitalization for HF. Methods: In the retrospective phase of this study, analysis of the admission and 30, 60 to 90-day rehospitalization rates in HF patients at University Medical Center (UMC) between Oct 2010 and Oct 2013 was done. Inclusion criteria were: admission/re hospitalizations with HF. This included all stages of HF and both HF with reduced and preserved ejection fraction groups. Exclusion criteria were: patients lost to follow-up, death in hospital, transfer to another acute care facility, and discharge against medical advice. Demographics were also obtained. This phase was done as a baseline with primary purpose of studying the patterns of HF admissions in the index institution. In the prospective phase, data were collected from HF patients’ hospitalizations between September 2014 and February 2015. Inclusion/exclusion criteria were same as in retrospective phase. In this phase, the patients were randomly assigned to 2 groups: control and intervention. The control group received standard management for heart failure. The study (intervention) group received additional education that included keeping daily log of body weights and communications to Health Provider when post discharge weight exceeded 5 pounds. For both arms, HF rehospitalizations within 30 and 60-90 day periods were studied. Results: The HF 30-day rehospitalizations had an average rate of 18% over a 2 year period in the retrospective study. This was statistically not different from the HF 30-day rehospitalizations in the control arm of the prospective study. Following intervention, the HF 30-day rehospitalizations were fewer in the intervention group than in the control (6% [3 of 50] vs 18% [9 of 50]respectively; P < 0.05). Additionally, the HF 60 to 90-day rehospitalizations were fewer in the intervention group than in the control (10%[5 of 50] vs 30%[15 of 50] respectively; P < 0.05). Conclusion: Proactive monitoring of body weights in HF patients will lead to reduced HF rehospitalization in the short term. Subsequent studies will focus on longer term monitoring of HF rehospitalizations.