Heart Failure Protocol Could Reduce Transfers

Abstract

ORLANDO – Rehospitalization rates for nursing home residents with heart failure might decrease if facilities adopt a protocol to identify, track, and manage this population, according to a study of more than 1,400 people with heart failure. The condition was common among people who were admitted to two skilled nursing facilities in 2008, investigator Megan Frantz said. About 14% of 1,042 people admitted to one facility that year had heart failure, as did 21% of 381 people admitted to the second nursing home. But neither facility had a heart failure–management program nor a system to document core clinical measures. “We are trying to capture the scope of the problem with a snapshot of two facilities,” Ms. Frantz, a medical student at Case Western Reserve University in Cleveland, said. “A lot of patients with heart failure in these facilities have higher rates of rehospitalization.” Using diagnosis codes and staff surveys, Ms. Frantz and her colleagues found that 18% of residents with heart failure at “facility A” had at least one rehospitalization, compared with 10% of those residents without heart failure. The difference was even more striking at “facility B,” where 43% of heart failure residents were readmitted to hospitals, compared with 18% of residents without the diagnosis, said Ms. Frantz in an interview at the annual meeting of the American Geriatrics Society. “It should be a priority to create a heart failure–management program so you can work on reducing rates of rehospitalization,” Ms. Frantz said. At least know your heart failure patients and track them. Place a large red heart sticker on their chart at admission, she suggested. Patient comorbidities were assessed using ICD-9 codes. Residents with heart failure had a higher mean number of diagnosis codes than did residents without heart failure: 6.9 codes vs. 5.0 among residents at facility A and 8.6 vs. 6.6 codes at facility B. Educational initiatives about heart failure disease management for both staff and residents at skilled nursing facilities are warranted, Ms. Frantz said. She said she had no relevant financial disclosure to make. Damian McNamara is with the Miami bureau of Elsevier Global Medical News. “It is estimated that about 10 in every 1,000 individuals over the age of 65 will develop heart failure. It is also worth noting that about 80% of patients hospitalized with heart failure are over the age of 65 years,” said Hosam K. Kamel, MD, CMD, associate clinical professor of geriatrics, University of Arkansas for Medical Science and St. Joseph's Mercy Health Center, Hot Springs. “More Medicare dollars are spent managing patients with heart failure than are spent on patients with any other diagnosis.” As chair of the panel that recently revised AMDA's clinical practice guideline “Heart Failure,” Dr. Kamel noted that the CPG “addresses the recognition, assessment, and management of patient with heart failure who reside in long-term care (LTC) facilities. Implementation of this CPG should help LTC facilities improve the following outcomes: ▸ Recognition, assessment, treatment, and monitoring of heart failure in the LTC facility. ▸ Staff education and awareness of heart failure. ▸ Appropriate use of medications to treat heart failure. ▸ Greater individualization of care. ▸ Enhanced quality of life for patients with heart failure. ▸ Facilitation of patient-centered care goals. ▸ Reduction in potentially avoidable hospitalizations of heart failure.”