Identifying Addressable Factors That Impact Heart Failure Readmissions: Cognitive Impairment, Anemia And Chronic Kidney Disease

Abstract

Introduction Heart Failure (HF) is a leading cause of hospitalization, 30 day readmissions and a health care burden. Preventing readmissions is priority. Although immediate management and counseling of patients occurs routinely, several comorbid factors may not receive recognition or be adequately addressed. Hypothesis Non-adherence to diet and medications is well recognized as contributory to readmissions for HF. Many other factors may impact HF readmissions, warranting consideration. As a QI project, we studied the prevalence of the following 4 factors in patients with HF, that were addressable during or after hospitalization. Cognitive impairment: adversely influences adherence to diet, medications, follow-up; Anemia: adversely affects cardiac function and may be treatable; Chronic Kidney Disease (CKD): warrants revisions of medication regimens, especially diuretics, ACE inhibitors, etc; Advance directives: presence or absence alters management approaches Methods In August 2017, a team of 9 Internal Medicine Residents were provided individual hands-on sessions in evaluating and counseling HF patients in 2 medicine units. As a QI project, data was gathered on age, gender, comorbidity and basic lab including hemoglobin, serum creatinine. If anemic, a search for etiology was prompted. Residents were taught to evaluate for cognition using the Mini-Cog (3 item recall + clock drawing). In the cognitively impaired, education was offered to the caregiver, if available. CKD was identified. Patients were asked about advance directives with opportunity to implement if interested. Results The trained resident team evaluated 44 patients with HF (Sept - Dec 2017) and addressed the 4 factors stated above. See table. Conclusions Although age is non-modifiable, several addressable factors that impact outcomes, including readmissions, are prevalent in patients with HF. The findings call for targeted approaches: o counsel the caregiver if patient is cognitively impaired; o evaluate etiology of anemia; attempt correction if appropriate; o revise medication regimens in those with CKD; o and address advance directives.