Abstract
Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.
Highlights
Heart failure is a major health problem in the developed world representing a substantial portion of emergency department (ED) presentations and admissions, and it is a leading reason for hospitalizations globally [1]
The first opportunity to prevent readmission occurs before the patient is discharged from hospital, by the identification of patients who are at highest risk of readmission
While the primary intervention did not significantly reduce readmission at 90 days, there was a significant impact in the subset of patients whose cardiologists were more reachable by the surveying nurse (HF readmission rate 2 vs. 14 %), presumably due to improved physician response to symptomatic changes [58]
Summary
There was substantial variability in the number of patients involved (ranging from 257 to 42,731), follow-up duration (60 days to 1 year), and variation in outcomes from hospital readmission, composite of readmission or death, or heart-failure-specific readmission. Our review identified an additional five studies modeling heart failure readmission risk.
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