30-day Heart Failure Readmission Rate Research Articles

Machine learning-based 30-day readmission prediction models for patients with heart failure: a systematic review.

Heart failure (HF) is one of the most frequent diagnoses for 30-day readmission after hospital discharge. Nurses have a role in reducing unplanned readmission and providing quality of care during HF trajectories. This systematic review assessed the quality and significant factors of machine learning (ML)-based 30-day HF readmission prediction models. Eight academic and electronic databases were searched to identify all relevant articles published between 2013 and 2023. Thirteen studies met our inclusion criteria. The sample sizes of the selected studies ranged from 1778 to 272 778 patients, and the patients' average age ranged from 70 to 81 years. Quality appraisal was performed. The most commonly used ML approaches were random forest and extreme gradient boosting. The 30-day HF readmission rates ranged from 1.2 to 39.4%. The area under the receiver operating characteristic curve for models predicting 30-day HF readmission was between 0.51 and 0.93. Significant predictors included 60 variables with 9 categories (socio-demographics, vital signs, medical history, therapy, echocardiographic findings, prescribed medications, laboratory results, comorbidities, and hospital performance index). Future studies using ML algorithms should evaluate the predictive quality of the factors associated with 30-day HF readmission presented in this review, considering different healthcare systems and types of HF. More prospective cohort studies by combining structured and unstructured data are required to improve the quality of ML-based prediction model, which may help nurses and other healthcare professionals assess early and accurate 30-day HF readmission predictions and plan individualized care after hospital discharge. PROSPERO: CRD 42023455584.

Gender differences in clinical features and outcomes of patients over 75 years presenting with acute heart failure. Results of a nationwide study (2016-2019).

Heart failure (HF) is a major health problem in Western countries, and a leading cause of hospitalizations and death. There is a scarcity of data on the influence of sex on HF outcomes in elderly patients. The aim of the present study was to analyze differences between men and women in clinical characteristics, in-hospital mortality, 30-day HF readmission rates, cardiovascular mortality and HF readmission rates at 1 year after discharge in patients older than 75 years hospitalized for HF in Spain. Retrospective analysis of patients discharged with a main diagnosis of HF from all Spanish public hospitals between 2016 and 2019. Patients aged 75 years or older were selected, and a comparison was made between male and female patients. From 2016 to 2019, a total of 354,786 episodes of HF in this age subgroup were identified, 59.2% being women. The overall mean age was 85.2 ± 5.4 years, being higher in women (85.9 ± 5.5 vs. 84.2 ± 5.3 years, p < 0.001). Risk-adjusted in-hospital mortality was lower in women (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.92-0.97; p < 0.001). Female sex also showed a protective effect for 30-day readmissions, with an OR of 1.06 (95% CI: 1.04-1.09; p < 0.001). One-year cardiovascular mortality (24.1% vs. 25.0%; p < 0.001) and one-year HF readmission rates (30.8% vs. 31.6%; p = 0.001) were lower in women. Almost 60% of hospital admissions for HF in people aged 75 years or older between 2016 and 2019 in Spain were female patients. Female sex seems to play a protective role on in-hospital mortality and the rate of admissions and mortality at 1 year after discharge.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Abstract 16307: Does the Method of Calculating the 30-day Readmission Rate After Hospitalization for Heart Failure Matter? Data From the VancOuver CoastAL Acute Heart Failure Registry

Introduction: The 30-day readmission rate after a heart failure (HF) hospitalization is widely used for assessing healthcare quality and system performance. However, there are different methodological approaches which may influence estimated rates, and no single accepted approach. The combined impact of these methods is unknown. Goals: We calculated 30-day HF readmission rates (RRs) of hospitalized patients using different published approaches to sampling and measurement. Methods: We included 1,849 patients discharged following unplanned hospitalization with a primary diagnosis of HF between 2016 to 2018 from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. We combined five distinct methodological factors (Table 1) to create 64 unique definitions and associated HF RRs. The readmission rates were averaged over 3-years. Multiple linear regression was used to determine the impact of different factors on estimated readmission rates. Results: The calculated 30-day RR for HF varied more than twofold depending solely on the methodological approach (6.4% to 15.0%, 8.6% absolute difference, 134% relative difference). The rates were highest when including all consecutive index admissions (11.1% to 15.0%), and lowest including only one index admission per patient per year (6.4% to 11.4%). The regression model ranked variables affecting RR as: index selection method, reference period, ICD-10 codes, 30-day survival, and index day (Table 2, p&lt;0.001 in all). Conclusions: Our findings have important implications for policy and reporting. Transparent and consistent methods are needed to calculate 30-day RRs to ensure reproducible and comparable reporting.

Evaluation Of Post-acute Follow-up On 30-day Heart Failure Readmission Rate In Patients With And Without Dialysis-dependent End Stage Renal Disease

Evaluation Of Post-acute Follow-up On 30-day Heart Failure Readmission Rate In Patients With And Without Dialysis-dependent End Stage Renal Disease

Abstract 14287: Development of an Innovated Heart Failure Hospitalist Program Drives Best Practice and Exceptional Outcomes From 2018-2021

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Hypothesis: The UPMC Hospitalist and Cardiology leadership recognized the need to foster consistent inpatient hospitalist providers, which was lacking in the current model. The concept of a dedicated Heart Failure Hospitalist service line emerged. Methods: Patients with both primary HF: UPMC Hospitalist, Cardiologist, teaching service N= 4192 (70%); CHF hospitalist Team N=1785 (30%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups from 2018-2021. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all providers is 21% from 2018-2021, matching the national average. HF Hospitalist team (only at Harrisburg Hospital) has consistently lower readmission rates: 9% (2018), 8.34% (2019), 8.6% (2020), 6.95% (2021). HF hospitalist length of stay was also consistently lower, by 0.5 to 0.9 days. Potential cost savings to UPMC hospitals is $1.5 million dollars since start of HF Hospitalist service line. Conclusions: Heart failure is a major health care issue. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. The HF Hospitalists provide quality care with frequent daily rounding, optimization of HF medications, providing education to the patient and family to improve treatment plan adherence, as well as engaging in early discussion of palliative and hospice transition. At this community-based healthcare system, HF Hospitalist outcomes include decreasing length of stay; decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 4yrs of the HF Hospitalist service line at UPMC.

Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy.

Heart failure readmissions are common, though some are preventable through evidence-based management. Despite outperforming national benchmarks for 30-day readmissions, compliance with an evidence-based institutional heart failure management pathway was inconsistent. The purpose of this project was to reduce 30-day heart failure readmission rates through an educational intervention and an electronic health record (EHR) redesign. The cardiac services nursing leadership team conducted an education and documentation needs assessment to identify knowledge gaps and practical barriers to effective utilization of evidence-based interventions for heart failure management. This intervention included an Advanced Cardiovascular Education (ACE) Academy and an EHR workflow redesign for clinical and supportive nursing staff. The 30-day heart failure readmission rates reduced immediately following the intervention, and rates continued to decrease over a 3-year follow-up. Even among hospitals outperforming national benchmarks, 30-day heart failure readmissions can be reduced and sustained with enhanced education and EHR redesign.

Role of Pocket Ultrasound in Assessing Intravascular Volume to Guide Management in Heart Failure Patients with Renal Impairment.

IntroductionInpatient management of patients with heart failure (HF) and renal impairment is challenging. We sought to evaluate the role of pocket ultrasound (US)-guided management of this patient population.MethodsWe prospectively included patients with acute HF exacerbation and renal impairment admitted to the HF service in our University hospital from January 2017 to August 2018. We compared the outcomes of patients who received US-guided management with those who received standard of care management. The main study outcome was the change in estimated glomerular filtration rate (eGFR). Multivariable logistic analysis was used to adjust for basic demographics and risk factors.ResultsA total of 211 patients with renal impairment presenting with acute HF exacerbation (mean age 66.8 ± 14.6 years, 41% females, 62% white) were enrolled in the study, of whom 69 (32.7%) received US-guided management and 151 (68%) received standard of care management. The change in the eGFR was significantly lower in US-guided group than in the group receiving standard of care (1.1 ± 4.3% vs. − 11.15 ± 2.9%; p = 0.04). No significant difference was observed between the patient groups in the length of stay (6.45 ± 0.38 vs. 6.44 ± 0.56; days; p = 0.98) and in the 30-day HF readmission rate (hazard ratio 1.27, 95% confidence interval 0.28–5.6; p = 0.75).ConclusionUltrasound-guided management of patients admitted with acute HF exacerbation and renal impairment may be beneficial in preserving kidney function. US provides a simple easily accessible tool to guide the management of patients with HF.

OR6. Heart Failure Hospitalist Program: Innovation Drives Best Practice and Exceptional Outcomes

Purpose This presentation will describe a creative, integrated care-model for heart failure (HF) management. Two key areas of focus will be consistent, patient-centered care across the continuum and innovative inpatient strategies. Objectives HF Hospitalist Program objectives have three focuses: • Patient care delivered by a consistent provider resulting in ongoing development of goals of care, resolution of barriers to care and improved patient satisfaction. • Team engagement to coordinate care of high-risk patients, develop plans for transition of care/advanced HF management and consult other interdisciplinary teams. • System opportunities include reduction of 7-day and 30-day readmissions, reduction in length of stay, adherence to HF metrics, and early introduction of Palliative/Hospice. Methods After analysis of HF data by Cardiology and Hospitalist leadership, all parties recognized that consistent inpatient provider care was lacking in the current care-model. The concept of a dedicated Heart Failure Hospitalist service line emerged. Key strategies included: 1) Optimizing care by patient rounds at least twice daily 2) Documentation template to highlight guideline directed therapy, response to treatment and a transition plan (attachment 1) 3) Leading morning huddle and afternoon interdisciplinary rounds 4) Overseeing all non-critical care heart failure admissions in the emergency room and direct admissions 5) Coordinating care with the HF Program manager/Clinical Nurse Specialist and outpatient HF Center to improve metrics such as 5-7 day appointments and 72-hour re-evaluation to assure action plans for yellow day 6) Reducing emergency room utilization by: • Community Paramedicine program referrals for in-home evaluation and administration of IV diuretics • Flagging chronic/high utilizer records • Delivering care in observation units, avoiding costly admissions. Results HF Hospitalist Program and all provider outcomes were compared from 2018-2020. Critical organizational objectives were met. Length of stay for HF hospitalist program was lower by .5 to 1.3 days (see table #1). Guideline directed medical therapy was consistently supported by HF team. Adherence with order set usage, averaged 96.2% for hospitalist team as compared to 81.1% for all providers (see Table #2). Consistent with program objectives to provide compassionate management of end-of-life care and support goals of care discussions, the HF Hospitalist program facilitated more hospice discharges than all providers over 3 years. (see Table #3). All-cause 30-day HF readmission rates were at a system low for all providers in 2018 at 17.22% and currently average 21%. HF Hospitalist team impressively lowered this metric to 9% (2018), 8.34% (2019) and 5.34% (2020). Readmission with HF at 30-days for all providers averaged 7.6%, while the HF Hospitalist team averaged 3.41%. (see Tables #4&5) Conclusions Heart failure is a major health care issue, challenging all medical centers to develop a plan to tackle high prevalence, mortality, and cost of care. This organization's strategy of partnering a HF hospitalist service line with a successful Heart Failure Center, which maintains continuity of care, has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. Attachment #1 Documentation Template Acute on chronic diastolic heart failure (HCC) – (present on admission) Echocardiogram: Chief Complaint: NYHA admission: NYHA current: Device: Etiology for HF exacerbation: Compliance with medications: Compliance with diet: HF order set: BNP on admission: BNP at discharge: Admission Weight: Current Weight: Diuretic (home medication): Diuretic (inpatient): CKD Stage: Cr trend: Urine Output in last 24hrs: NET Output: Current HF medications: -Beta-blocker: -ACEI/ARB/ARNI: -Aldosterone Antagonist: # of Admissions last 6 months: Social Support: Hospice Discussion: TOC Appointment: Heart Failure Hospitalist Outcomes Compared to All Providers 2018-2020 YTD

A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis.

BackgroundPatients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era.ObjectiveThe aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population.MethodsWe performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF.ResultsWe observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient.ConclusionsThe investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

The relevance of specific heart failure outpatient programs in the COVID era: an appropriate model for every disease.

Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.

Implementation of a Disease Management Program in Adult Patients With Heart Failure.

Approximately 5.7 million people in the United States are diagnosed and living with heart failure (HF), with projected prevalence rates to increase 46% by 2030. Heart failure leads hospital admissions in the United States for individuals 65 years or older, with many acute exacerbation admissions resulting from a lack of medication management, poor patient treatment plan adherence, and lack of appropriate follow-up within the health care system. In 2017, the 30-day HF readmission rate at the facility of implementation was 27%, 3% higher than the national average and, more specifically, 18.5% for the cardiac care unit (CCU). The aim of this study was to develop an HF disease management program to reduce 30-day readmission rates for HF patients through the implementation of a structured program including self-care education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. The implementation of the disease management program took place at a major military treatment facility in the continental United States. The facility is a teaching facility housing a 272-bed multispecialty hospital and an ambulatory complex. The implementation took place on the CCU, the primary unit for cardiac admissions, with approximately 30 admissions a month for a primary diagnosis of HF. In August 2018, a multidisciplinary disease management program was implemented to include patient education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. Data were collected and analyzed for 90 days and compared with retrospective data from 2017. Participants in the disease management program had a statistically significant improvement (p < .001) in the hospital readmission rate. The overall 30-day readmission rate decreased from 27% to 10.2% during the implementation period, a decrease of 38%. Ninety-three percent of the patients completed the self-care education, and telephone follow-up was successfully achieved with 96% of these patients. Only 4 patients in the HF disease management program experienced readmission within 30 days. Patients and caregivers reported increased satisfaction with their care due to the disease management program and increased follow-up with care. The findings of this innovation suggest that a multidisciplinary disease management program can reduce avoidable 30-day readmissions. The program improved patient follow-up and decreased follow-up appointment no-shows. Multiple participants expressed increased patient satisfaction. The program supports the need for coordinated, interdisciplinary disease management to improve the quality of life of those affected by HF and improve the use of resources to reduce the overall health care burden. Case management is critical to the organized care of HF patients due to the complex, individualized care to achieve optimum patient outcomes.

Myocardial Recovery in Dilated Cardiomyopathy with Goal Directed Medical Therapy

Background Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF). Goal Directed Medical Therapy (GDMT) for HF has been shown to improve mortality and morbidity but rate of myocardial recovery is not well known. Methods In this retrospective study, 325 patients with newly diagnosed systolic heart failure (LVEF 10% and maintained >6 months. At baseline, all patients underwent echocardiogram; additionally, 22% underwent cardiac MRI, 7% cardiopulmonary stress test and 14% right heart catherization. GDMT was initiated inpatient and titrated weekly the first month, biweekly for the second month and monthly thereafter in our HF clinic. At discharge, 25% of the patients were sent home with wearable cardioverter-defibrillator (WCD). Results Of the 325 patients, 148 patients (45.5%) had myocardial recovery. In the recovery group, average age was 55.0 years, 58.8% were males, 64.9% Caucasians and 30.0% African Americans. At baseline, average LVEF was 27.3% and NYHA class 2.3. Average time for myocardial recovery was four months post initiation of GDMT. At one-year follow-up, average LVEF was 48.6% and NYHA class 1.7. In the recovery group, 84.0% were on ACEI/ARB/ARNI, 95.3% BB, 59.5% MRA, 4.7% Hydralazine, 2.7% Nitrates and 13.4% on Digoxin. No malignant arrhythmias were noted in patients discharged with WCD. The 30-day HF readmission rate in the myocardial recovery group was Conclusion GDMT for HF is well established and with aggressive medication titration in newly diagnosed systolic HF due to DCM and NICM, myocardial recovery is possible with rates as high as 45.5% at one-year.

Reducing Readmissions for Heart Failure.

Reducing Readmissions for Heart Failure.

Early Goal Directed Sepsis Management in Patients with Heart Failure and Concomitant Chronic Kidney Disease

Current guidelines recommend for the use of protocolized quantitative fluid resuscitation in patients with sepsis. Limited data is available regarding optimal fluid management in patients with sepsis and concomitant heart failure (HF) and/or chronic kidney disease (CKD). Methods: This is a single center retrospective cohort study of patients diagnosed with sepsis and concomitant HF and CKD (K-HF) between January of 2015 and December of 2018. The primary outcome includes all cause in-hospital mortality. Secondary outcomes include length of stay, requirement of intravenous diuretics, need for renal replacement therapy, and 30-day heart failure readmission rate. Results: This cohort of 1116 patients included 621/1116 (55.64%) men with a mean age of 76 ± 14 years (see Table I for baseline characteristics). A total of 383/1116 (34.31%) patients had K-HF and 733/1116 (65.68%) did not have K-HF. Patients with K-HF received an initial bolus intravenous fluid (IVF) administration of 1.63 liters vs. patients with non-K-HF and sepsis who received 1.77 liters (p=0.1766). Mortality was 121/383 (31.93%) for patients with K-HF vs. 199/733 (27.26%) for non-K-HF patients (p=0.1084). 30-day readmission was 56/383(15.73%) in patients with K-HF vs. 112/733 (16.62) in patients with non-K-HF. In patients with sepsis with K-HF 204 (53.54%) developed AKI vs. 327 (44.61%) in non-K-HF patients. Renal replacement therapy (RRT) was required in 90/383 (23.69%) in patients with K-HF vs 327/733(44.61%) in non-K-HF patients. Conclusion: EGDT in patients with sepsis and concomitant HF and CKD shows diverse morbidity, however, with similar mortality in this special population.

Predictors of Heart Failure Readmission in a High-Risk Primarily Hispanic Population in a Rural Setting.

High risk for readmission in patients with heart failure (HF) is associated with Hispanic ethnicity, multimorbidity, smaller hospitals, and hospitals serving low-socioeconomic or heavily Hispanic regions and those with limited cardiac services. Information for hospitals caring primarily for such high-risk patients is lacking. The aim of this study was to identify factors associated with 30-day HF readmission after HF hospitalization in a rural, primarily Hispanic, low-socioeconomic, and underserved region. Electronic medical records for all HF admissions within a 2-year period to a 107-bed hospital near the California-Mexico border were reviewed. Logistic regression was used to identify independent predictors of readmission. A total of 189 unique patients had 30-day follow-up data. Patients were primarily Hispanic (71%), male (58%), and overweight or obese (82.5%) with 4 or more chronic conditions (83%) and a mean age of 68 years. The 30-day HF readmission rate was 5.3%. Early readmission was associated with history of HF, more previous emergency department (ED) and hospital visits, higher diastolic blood pressure and hypokalemia at presentation, shorter length of stay, and higher heart rate, diastolic blood pressure, and atrial fibrillation (AF) at discharge. Using logistic regression, previous 6-month ED visits (odds ratio, 1.5; P = .009) and AF at discharge (odds ratio, 5.7; P = .039) were identified as independent predictors of 30-day HF readmission. Previous ED use and AF at discharge predicted early HF readmission in a high-risk, primarily Hispanic, rural population in a low-socioeconomic region.

PCV82 FACTORS ASSOCIATED WITH UNPLANNED 30-DAY HEART FAILURE READMISSION RATES AMONG MEDICARE AND MEDICAID PATIENTS IN TEXAS

The study aimed to determine an association between unplanned 30-day Heart Failure (HF) readmission rates and factors outside of hospital’s control among Medicare and Medicaid patients in Texas. We used the Texas Hospital Inpatient Research Data File (RDF) to select Medicare and Medicaid patients discharged with a principal diagnosis of heart failure (HF) during the January 1st, through December 31st, 2014. We applied an endorsed measure by the National Quality Forum (NQF) to develop analytic sample. Multi-level logistic regression analyses examined patient-level and community-level characteristics. The unplanned 30-day HF readmission rates were 20.76% in Medicare (5,392 readmission/25,978 HF admission) vs. 30.63% in Medicaid (939 readmission/3066 HF admission). Controlled for other factors, Medicaid patients were 1.51 times more likely to be readmitted within 30 days than Medicare patients. (OR: 1.51 95% CI 1.38 - 1.65, p< 0.001). Patients lived in area with higher median household income were less likely to be readmitted (OR: 0.89, 95% CI 0.83 - 0.95, p < 0.001). The odds ratios were significantly lower in counties with higher density of health professionals (Primary care physician per 100K - OR: 0.89, 95%CI 0.80 - 0.99, p=0.025, Ratio general practitioner to specialist – OR: 0.89 95%CI 0.80 - 0.99, p=0.025, Hospital bed per 100K – OR: 0.90, 95%CI 0.83 - 0.99, p=0.032). Policy makers should consider a multidisciplinary strategy to help hospitals serving higher composition of patients with lower socioeconomic status or lower access to care to achieve higher performance.

Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center

Persons living with HIV (PLHIV) have an increased risk of heart failure (HF). However, little is known about outcomes among PLHIV with HF. The study aim was to compare HF outcomes among PLHIV with HF versus individuals without HIV with HF. Our cohort included 2,308 individuals admitted with decompensated HF. We compared baseline characteristics, 30-day HF readmission, and cardiovascular (CV) and all-cause mortality. Within PLHIV, we assessed outcomes stratified between CD4 count and viral load (VL), and tested the association between traditional and HIV-specific parameters with 30-day HF readmission. There were 374 (16%) PLHIV with HF. Among PLHIV, 92% were on antiretroviral therapy and 63% had a VL <200 copies/mL. Groups were similar with respect to age, sex, race/ethnicity, and CV risk factors. In follow-up, PLHIV had increased 30-day HF readmission (49% vs 32%) and CV (26% vs 13.5%) and all-cause mortality rates (38% vs 22%). Among PLHIV, cocaine use, HIV-specific parameters (CD4, VL), and coronary artery disease were predictors of 30-day HF readmission. Specifically, among PLHIV, those with detectable VL had higher 30-day HF readmission and CV mortality, whereas PLHIV with undetectable VL had a similar 30-day HF readmission rate and CV mortality to uninfected controls with HF. Similar outcomes were observed across strata of left ventricular ejection fraction and by CD4. PLHIV with a low CD4 count or detectable VL have an increased 30-day HF readmission rate as well as increased CV and all-cause mortality. In contrast, PLHIV with a higher CD4 count and undetectable VL have similar HF outcomes to uninfected controls.

Transitions in Care From Acute Care Telemetry Unit to Home: An Evidence-Based Quality Improvement Project.

Transitions in Care From Acute Care Telemetry Unit to Home: An Evidence-Based Quality Improvement Project.

Effect of Pharmacist Clinic Visits on 30-Day Heart Failure Readmission Rates at a County Hospital.

Purpose: This study evaluated the comparative effectiveness of different pharmacist visit types on reducing readmission rates. Method: A single-center, retrospective cohort study was conducted from January 2015 to July 2017. Patients were 18 years or older with an index heart failure (HF) exacerbation admission. Upon hospital discharge, patients were seen in clinic by a clinical pharmacy specialist (CPS) with collaborative practice agreement (CPA) (High Intensity Bundle), medication therapy management (MTM) pharmacist without CPA (Low Intensity Bundle), or no pharmacist (Standard of Care [SOC]). The primary outcome was 30-day all-cause readmission rate. Secondary outcomes included rate of 30-day HF readmissions and average number of days until readmission in those who were readmitted. Results: Totally, 98 patients were included in the final analysis (35 High Intensity Bundle, 28 Low Intensity Bundle, and 35 SOC). The primary outcome of all-cause readmissions was lower in both the pharmacist groups compared with SOC (CPS 8.6% [3/35] vs SOC 25.7% [9/35], P = 0.046 and MTM 7.1% [2/28] vs SOC 25.7% [9/35], P = 0.057). Incremental differences were seen between visit types for the secondary outcome of 30-day HF readmissions (CPS 2.9% vs MTM 7.1% vs SOC 17.1%, P = 0.039). The average number of days until readmission was longer in the CPS versus the MTM and SOC (26.7 days vs 12.5 days vs 14.1 days, respectively). Conclusion: Post-hospital discharge pharmacist visits were associated with lower 30-day all-cause readmission. In particular, clinic visits with a Higher Intensity Bundle may be more effective in reducing HF readmissions. These exploratory findings warrant further investigation.