Congestive Heart Failure Readmission and Guideline Based Therapy Rates Improvement At Safety Net Hospital Heart Health Center

Abstract

Introduction The 2017 HFSA co-sponsored guidelines on heart failure (HF) focus on developing strategies to lower readmission rates and increase adherence to guideline directed medical therapy (GDMT), specifically beta blockers (BB), ACE inhibitors and Angiotensin II receptor blockers (ACEi/ARB), spironolactone, Bidil or combined hydralazine/isosorbide dinitrate (Hydral/ISDN), and ARB with neprilysin inhibitor (ARNI). Patients with HF at a disproportionately elevated risk for readmission are those in median-low income, often minority populations, at public safety net hospitals. The Heart Health Center (HHC) at NYC Health + Hospitals, Kings County, the largest public hospital in Brooklyn, New York, was established in October 2017 to provide comprehensive integrated inpatient-outpatient HF care coordinating the management of patients hospitalized on the inpatient cardiology primary service and the outpatient multidisciplinary HF clinic. Hypothesis High-risk patients hospitalized at public medical centers and safety net hospitals with HF have improved rates of rehospitalization GDMT utilization when admitted to dedicated cardiology inpatient primary services and care teams. Methods Retrospective review was conducted of patients admitted with HF from November 2017 - November 2018 referred for post-discharge HHC HF clinic follow up, with readmission monitored through November 2019. Patients admitted to cardiology telemetry service (CT), the inpatient arm of the HHC, were compared to patients admitted to general medicine service (GM). Two-proportion z testing was performed for analysis for 30-day and 1-year overall, HF, and non-HF readmission. Odds ratio (OR) and confidence interval (CI) via McNemar were used for analysis of admission and discharge GDMT changes. Results CT patients (n=125) exhibited lower 30-day and 1-year overall, HF, and non-HF readmission rates than GM (n=69) patients, with 30-day overall readmission rates being significant (24% v 39.1%, p=0.04). When comparing admission and discharge medication reconciliations, CT patients had significantly increased likelihood of being discharged on all classes of GDMT, BB (OR 22.5, CI 5.9 - 191.5, p Conclusions Among HF patients at a public safety net medical center at high risk for readmission, hospitalization under a primary cardiology care team in an integrated inpatient-outpatient HF service was associated with improvement in readmission outcomes and GMT adherence. This study has important implications for strategies for safety net hospitals and medical centers serving broader populations.