Strategies to Reduce Heart Failure Readmissions

Abstract

To the Editor The Viewpoint by Dr Butler and colleagues 1 seems to misinterpret our recent work 2 by suggesting that none of the 10 widely promoted strategies for reducing readmission for patients with heart failure was effective. Our study 2 evaluated the relationship between riskstandardized readmission rates and hospital strategies to improve transitions in care. A total of 599 hospitals (91% response rate) enrolled in the Hospital-to-Home quality campaign sponsored by the American College of Cardiology completed the survey. We found several individual strategies that were associated with significantly lower risk-standardized 30-day readmission rates in multivariable analysis. These strategies included partnering with community physicians and physician groups, partnering with local hospitals, having nurses responsible for medication reconciliation, arranging for follow-up visits before discharge, having a process in place to send all discharge or electronic summaries directly to the patient’s primary care physician, and assigning staff to follow up on test results after the patient is discharged. Hospitals that implemented more strategies had lower readmission rates by a clinically significant margin, although the magnitude of effects for any single strategy was modest. Physicians and researchers may be more satisfied with a magic bullet that single-handedly reduces readmissions; however, it is prudent to recognize the complexity of these processes and accept that multiple simultaneous interventions are needed to lower readmissions. If findings such as ours are misinterpreted to conclude nothing works, the national goals for improving important patient outcomes are unlikely to be achieved.