Inspire - HF Manifesto Reduces Readmissions And Improves Outcomes In Chronic Heart Failure

Abstract

Introduction Multiple co-morbidity is common in patients with HF increasing their risk for poor health outcomes. In the US, approximately 40% of Medicare beneficiaries with HF have >5 non-cardiac conditions and this group accounts for >80% of the total inpatient HF-related hospital days in the US. Annual total costs for HF is more than $ 40 B and the majority (61%) of hospital readmissions are attributable to multimorbidity and occur within 15-days of discharge. Most of these HF admissions and readmissions are preventable. A proactive management strategies are needed to address all comorbidities such as hypertension, diabetes, dyslipidemia, metabolic derangement, worsening renal function, and repetitive hospitalizations that ultimately lead to loss of psychosocial and financial independence, anxiety, depression, poor coping skills, falls, sarcopenia and death. Hypothesis Use of a novel framework such as INSPIRE -HF will address multiple comorbidities and improve outcomes Methods A comprehensive, multidisciplinary, nurse-directed, physician guided heart failure management program including those with CKD was started in 2017. The goal of the Cardiorenal center is to reduce 30-day hHF, 90-day hHF, optimize GDMT, improve QOL, prevent CKD progression, and enhance survival .The program consists of intensive face to face weekly or bimonthly encounters in patients enrolled at this clinic within a week after discharge from the hospital for CHF. The multicomponent program consists of the INSPIRE HF framework: 1) Identify individualized priorities and nature of multimorbidity, 2) Nutrition intervention including management of diabetes, obesity, hypertension, dyslipidemia and poor functional capacity, 3) Stabilize fluid status 4) Psychosocial motivational empowerment and financial assistance as needed, 5) Initiate GDMT 6) Revisit comorbidities with biomarker assessments and 7) Education and exercise programs including EECP therapy for those who qualify. A total of 162 patients discharged from the hospital enrolled within a week at the clinic were followed for 30 months on a weekly or bimonthly basis. Results A total of 162 patients (Men 66 %, Systolic HF 69%, Ischemic etiology 55%, 35 % with diabetes, 27 % hypertensive and 58 % with CKD) were started on the INSPIRE Strategy driven protocol. Total of 27 patients (16 %) were admitted during the 30-month period of which 8 patients (5%) were readmitted within 30 days and 19 patients (11%) were readmitted in the subsequent 180 days. Twenty-seven patients have died (16.7%) during this period. Fifty-nine patients received IV diuretics at some point during their visits and averted readmission (37%). More than 90% improved by at least 1 NYHA functional class. Conclusion A comprehensive multiple comorbidity management strategy in a nurse directed physician guided outpatient cardiometabolic renal center using the INSPIRE HF manifesto improves HF outcomes.