Keeping PAPs down: Implementation of a Nurse-Led Pulmonary Artery Pressure Monitoring Program to Reduce Heart Failure Readmissions

Abstract

Background Heart Failure (HF) continues to be one of the leading causes of morbidity and mortality in the United States. Even with guideline directed medical therapy, readmission rates for heart failure remain high and are now associated with CMS financial penalties. The CHAMPION study, a randomized trial of an implanted pulmonary artery pressure monitoring device (CardioMEMSTM) which monitored, identified, and transmitted PAP changes to investigators, demonstrating a significant 48% reduction in hospital readmission rates. Despite the success of this device in a clinical trial setting, monitoring and management of daily transmissions can be challenging and resource intense. With physician and nurse practitioner oversight, we developed a nurse-led, protocolized PAP monitoring and management program at the Medical University of South Carolina (MUSC). After the CardioMEMsTM device is implanted, patients go through three monitoring phases during which their PAP thresholds are determined, and a diuretic plan is formulated. The dedicated CardioMEMsTM RN monitors PAPs according to the protocol and consults Advance Practice Nurses as needed (i.e. renal insufficiently, electrolyte imbalance, etc.). CardioMEMsTM team meetings to discuss specific cases and/or revise thresholds are held weekly and routinely include an attending physician. Purpose The aim of this study was to analyze the impact of a nurse-led PAP monitoring device implantation program in hospital admission rates at MUSC. Methods A retrospective chart review of patients who underwent CardioMEMSTMimplantation since the nursing lead protocol was instituted (January 2015) and had at least one year of follow-up. Patients were also included if they received a durable ventricular assist device, cardiac transplant or died within the first year post-implant. In keeping with product labeling, all patients had at least one hospital admission in the setting of HF within one year prior to implantation and New York Heart Failure Class III HF symptoms. A McNemar's test was utilized to compare hospitalizations rates in the year before and after implant. Results Twenty-four patients received a PAP monitoring device during the study period. Eighteen of the 24 patients were not admitted during the year following transplantation (p Conclusion Our nurse-led PAP monitoring program was effective in minimizing hospital admissions among NYHA class III HF patients and CardioMEMSTMdevice. These data support the key role of nurses HF management and optimizing resource utilization. As HF admissions continue to grow, nurse-led PAP monitoring programs are a successful and cost-effective intervention that may be implemented in both metropolitan and rural settings. Nurses play a key role in improving HF management and reducing the financial burden of hospitalizations to both patients and institutions alike.