30-day Heart Failure Readmission Rate Research Articles

Use of ReDS Technology to Treat Heart Failure in the Home Health Setting

Background Volume overload is a major determinant in the physical symptoms and quality of life in patients with heart failure (HF), as well as the predominant factor leading to HF admissions. Accurate assessment of a patient's volume status can be difficult. The Remote Dielectric Sensing (ReDS) Wearable System is an FDA-approved device developed by Sensible Medical Innovations that allows a health care provider to accurately, quickly and non-invasively measure lung fluid. In this study, we used the ReDS system to facilitate a nurse-led care transitions program to improve outcomes and reduce HF readmission rate in a rural hospital lacking an onsite HF program. Methods Randolph Hospital (RH) is a non-profit facility in central North Carolina with a 30-day HF readmission rate ≥ 25%. Medicare patients admitted for HF were enrolled into a nurse-led care transitions program. Patients received telephone follow up or home visit by a nurse within 3 days of discharge. Patients were instructed to call the care transitions nurse with any signs or symptoms of worsening HF during the follow-up period. If the patient complained of volume overload or increased dyspnea a nurse would travel to the patient's home to assess the patient and obtain a ReDS measurement. If the ReDS reading was consistent with volume overload (lung fluid > 35%), a specifically-designed diuretic protocol was initiated. Daily ReDS readings were performed and treatment protocol followed until the reading was below 35% or the protocol was stopped by the medical director. Renal function and electrolytes were monitored and replaced following pre-specified protocol. Results The Care Transitions Team has evaluated 61 patients thus far. There have been 32 elevated readings (ReDS > 35%) which triggered implementation of treatment using the diuretic-protocol. It took an average of 2.5 visits to titrate diuretics and obtain a reading Conclusions A nurse-led care transitions program employing ReDS technology and a specifically-designed diuretic protocol to manage HF patients post hospital discharge, was successful in reducing 30-day HF readmission and reduce overall resource utilization in a community hospital without a dedicated HF clinic.

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

BackgroundIncident heart failure (HF) is increased in persons with human immunodeficiency virus (PHIV). Protease inhibitors (PIs) are associated with adverse cardiac remodeling and vascular events; however, there are no data on the use of PIs in PHIV with HF. ObjectivesThis study sought to compare characteristics, cardiac structure, and outcomes in PHIV with HF who were receiving PI-based versus non-PI (NPI) therapy. MethodsThis was a retrospective single-center study of all 394 antiretroviral therapy–treated PHIV who were hospitalized with HF in 2011, stratified by PI and NPI. The primary outcome was cardiovascular (CV) mortality, and the secondary outcome was 30-day HF readmission rate. ResultsOf the 394 PHIV with HF (47% female, mean age 60 ± 9.5 years, CD4 count 292 ± 206 cells/mm3), 145 (37%) were prescribed a PI, whereas 249 (63%) were prescribed NPI regimens. All PI-based antiretroviral therapy contained boosted-dose ritonavir. PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower left ventricular ejection fraction. In follow-up, PI use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types. Predictors of CV mortality included PI use, CAD, PASP, and immunosuppression. Overall, PIs were associated with a 2-fold increased risk of CV mortality. ConclusionsPI-based regimens in PHIV with HF are associated with dyslipidemia, diabetes, CAD, a lower left ventricular ejection fraction, and a higher PASP. In follow-up, PHIV with HF who are receiving a PI have increased CV mortality and 30-day HF readmission.

Early Readmission Risk Identification for Hospitalized Older Adults With Decompensated Heart Failure.

The current study evaluated risk factors of early hospital readmission in geriatric patients with acute heart failure (HF) and analyzed 2,279 consecutively hospitalized older adults with decompensated HF from November 2013 to October 2014 across 15 U.S. hospitals. The eTracker-HF was designed to make risk factors known to treating clinicians in electronic health records. Multilevel multivariate logistic regression was applied to examine the association between risk factors and all-cause and HF 30-day readmission rates. All-cause and HF 30-day readmission rates were 22.3% and 9.8%, respectively. Old age, non-White ethnicity, delirium, physical impairment, ejection fraction <40%, advanced chronic kidney disease, and previous myocardial infarction were associated with all-cause and HF readmission. Home health care use was inversely associated with early readmission. In addition to demographic and cardiovascular risk factors, geriatric syndromes were associated with early readmission. Discharge to home health care may reduce early readmission in these patients. [Res Gerontol Nurs. 2018; 11(4):190-197.].

Sleep Apnea and Heart Failure With a Reduced Ejection Fraction Among Persons Living With Human Immunodeficiency Virus.

Sleep apnea (SA) is common and has prognostic significance among broad groups of patients with heart failure (HF). There are no data characterizing the presence, associations, and prognostic significance of SA among persons living with human immunodeficiency virus (PLHIV) with HF. We conducted a single-center study of PLHIV with HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction [LVEF] <50%) and analyzed the relationship of SA with 30-day HF hospital readmission rate. Our cohort included 1124 individuals admitted with HFrEF; 15% were PLHIV, and 92% were on antiretroviral therapy. SA was noted in 28% of PLHIV and 26% of uninfected controls. Compared to uninfected controls with HFrEF and SA, PLHIV with HFrEF and SA had a lower body mass index, lower LVEF, a higher pulmonary artery systolic pressure (PASP), were more likely to have obstructive rather than central SA (P < .05 for all). In a multivariable model, PASP, low CD4 count, high viral load (VL), and SA parameters (apnea-hypopnea index, CPAP use and duration) were predictors of 30-day HF readmission rate. Each 1-hour increase in CPAP use was associated with a 14% decreased risk of 30-day HF readmission among PLHIV. Compared to uninfected controls, PLHIV were more likely to have obstructive SA than central SA. Apnea severity, low CD4 count, high VL, and cocaine use were positively associated with 30-day HF hospital readmission rate, whereas CPAP use and increased duration of CPAP use conferred protection.

Association Between Energy Prices and US Hospital Patient Outcomes.

To evaluate associations between changing energy prices and US hospital patient outcomes. Generalized estimating equations were used to analyze relationships between changes in energy prices and subsequent changes in hospital patient outcomes measures for the years 2008 through 2014. Patient outcomes measures included 30-day acute myocardial infarction, heart failure, and pneumonia mortality rates, and 30-day acute myocardial infarction, heart failure, and pneumonia readmission rates. Energy price data included state average distillate fuel, electricity and natural gas prices, and the US average coal price. All of the price data were converted to 2014 dollars using Consumer Price Index multipliers. There was a significant positive association between changes in coal price and both short-term (P = 0.029) and long-term (P = 0.017) changes in the 30-day heart failure mortality rate. There was a similar significant positive association between changes in coal price and both short-term (P <0.001) and long-term (P = 0.002) changes in the 30-day pneumonia mortality rate. Changes in coal prices also were positively associated with long-term changes in the 30-day myocardial infarction readmission rate (P < 0.001). Changes in coal prices (P = 0.20), natural gas prices (P = 0.040), and electricity prices (P = 0.040) were positively associated with long-term changes in the 30-day heart failure readmission rate. Changing energy prices are associated with subsequent changes in hospital mortality and readmission measures. In light of these data, we encourage hospital, health system, and health policy leaders to pursue patient-support initiatives, energy conservation programs, and reimbursement policy strategies aimed at mitigating those effects.

Abstract 118: Physician Specific Practice Patterns and 30-day Heart Failure Readmission Rates: Is One Way Better Than the Other?

Background: Heart failure (HF) admissions place a significant burden on hospital resource utilization. Management of inpatient HF remains heterogeneous, from daily diuresis to discharge strategies. We sought to evaluate if specific physician practices were associated with two important contributors to resource utilization, readmission and length of stay (LOS). Methods: Physician-specific discharges, LOS, and 30-day readmission rates from 7/1/2015-6/30/2016 were extracted from the EHR. Patients with “shock” as the primary diagnostic code were excluded. We created a survey to assess HF management strategies that was administered to all cardiologists and hospitalists at our institution; physicians were blinded to LOS and readmission data. Many factors potentially impacting LOS and discharge decisions were queried, including physical examination, medication use and kidney function. Results: We received 62 of 69 (90%) survey responses – 26 cardiologists and 36 hospitalists. Overall, 52% (32 of 62) were male with a median 7 years in practice [IQR 3-13]. We tracked HF utilization metrics in 58 physicians, encompassing 753 patient discharges in the preceding year. Total 30-day readmission rate was 17.0% (128 of 753). No significant differences were seen in discharge practices between readmission rate tertiles. Median of the median LOS was 4.7 days (IQR 4.0-5.8), and physicians above median LOS were compared to physicians below median LOS. Point estimates suggest physicians with lower median LOS targeted a daily net diuresis goal greater than 3L (40% vs 11% for those above median LOS, p = 0.1), and were less likely to hold beta blockers (17% vs 37%, p = 0.1) or to consider 24 hours of inpatient oral diuretics prior to discharge to be “very important” (16% vs 56%, p &lt; 0.01). The pooled readmission rate of physicians below median LOS was not significantly different than those above median LOS (14.5% vs 16.2%, p = 0.6). Conclusions: We identified three specific HF management patterns that may be associated with lower LOS without a concomitant increase in 30-day readmission: (1) more aggressive daily diuresis, (2) continuation of beta blockade, and (3) not delaying discharge to observe 24 hours of an oral diuretic regimen. Further studies are warranted to confirm and quantify the impact of these changes on resource utilization.

Risk Stratification Model for 30-Day Heart Failure Readmission in a Multiethnic South East Asian Community

There are limited accurate 30-day heart failure (HF) readmission risk scores using readily available clinical patient information on a well-defined HF cohort. We analyzed 1,475 admissions discharged from our hospital with a primary diagnosis of HF between 2010 and 2012. HF diagnostic criteria included satisfying clinical Framingham criteria, elevated serum N-terminal pro-natriuretic peptide, and evidence of cardiac dysfunction on transthoracic echocardiography. The patients were randomly divided into 2 groups; 60% were used as the derivation cohort and 40% as the validation cohort. Bivariate analysis and logistic regression were used to develop the model. Weighted risk scores were derived from the odds ratio of the logistic regression model. Total risk scores were computed by simple summation for each patient. The 7 significant independent predictors of 30-day HF readmission used to derive the risk scoring tool were the number of previous HF-related admission in the preceding 1year, index admission length of stay, serum creatinine level, electrocardiograph QRS duration, serum N-terminal pro-natriuretic peptide level, number of Medical Social Service needs, and β blocker prescription on discharge. The area under the curve was 0.76. Sensitivity and specificity were 78.3% and 60.7%, respectively. The positive predictive value and negative predictive value were 18.9% and 96%, respectively. The actual observed and predicted 30-day heart failure readmission rates matched. In conclusion, we have developed the first 30-day HF readmission risk score, with good discriminatory ability, for an urban multiethnic Asian heart failure cohort with stringent diagnostic criteria. It consists of 7 easily obtained variables.

An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard.

Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort. We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF. After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF. The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% ( P = .0001), and the percentage of patients receiving our interventions, such as patient education, also improved significantly from 22% to 100% over time ( P < .0001). In an institution with a quality improvement program already in place to reduce 30-day readmission rates for HF, an EMR-based approach further significantly reduced 30-day index hospital readmission rates.

Association of 30-Day Readmission Metric for Heart Failure Under the Hospital Readmissions Reduction Program With Quality of Care and Outcomes

ObjectivesThis study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). BackgroundHRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF. However, it is unclear whether the differences in this metric of hospital performance used by HRRP and related penalties are associated with measured quality of care and long-term outcomes. MethodsWe analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publically available data on HF-ERR in 2013, we stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. We compared the care quality, in-hospital, and 1-year clinical outcomes across the 2 groups in unadjusted and multivariable adjusted analysis. ResultsThe analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the 2 groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07). ConclusionsQuality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates. These findings raise questions about the validity of the HRRP performance metric in identifying and penalizing low-performance centers.

226 - Successful Decrease in 30-Day Heart Failure Readmission Rate in a Quaternary Care Academic Hospital

226 - Successful Decrease in 30-Day Heart Failure Readmission Rate in a Quaternary Care Academic Hospital

The Effect of Enhanced Patient Education on 30-day Heart Failure Readmission Rates

The Effect of Enhanced Patient Education on 30-day Heart Failure Readmission Rates

Feasibility study of a nurse-led heart failure education program

Aims/Objectives: To assess the feasibility of a nurse-led heart failure (HF) education program using the Self-Care Heart Failure Index (SCHFI) instrument. Background: HF is a frequent and burdensome condition requiring support with self-care management strategies and education. Translating best practice to health services is important in improving health outcomes. Design: Longitudinal quasi-experimental design. Methods: A convenience sample of (N = 41) patients with HF. We implemented a nurse-led education program with 30-day post-discharge home-based telephone follow-up. The SCHFI was used to measure self-care behaviors. 30-day readmission rates were assessed. Results: A significant difference was found in scores for self-care maintenance (p ≤ .001) and self-care management (p ≤ .001) subscales, not self-care confidence. There was no statistically significant difference between 30-day HF readmission rates. Conclusions: Findings suggest that the nurse-led evidence-based HF education program improved self-care behaviors and decreased 30-day readmissions. There is a need for continued development of interventions focused on improving patient self-care confidence.

Disease management partnership with skilled nursing facility improves heart failure 30-day readmission rates

Heart failure (HF) and HF readmissions have reached epidemic proportions and highlight the importance of care transitions. Nationally, about one-quarter of HF patients are discharged to a skilled nursing facility (SNF). Typically, patients discharged to a SNF are more vulnerable than those discharged to home. Not surprisingly, one-quarter of these patients are readmitted to acute care hospitals within 30 days. In York, Pennsylvania, these patterns of readmission from SNFs are similar. To illustrate, approximately 23% of HF patients discharged from York Hospital to a SNF are readmitted within 30 days. To address this problem, a multidisciplinary team was formed to design and evaluate a quality improvement pilot to decrease HF readmissions from SNFs.

Variations in heart failure hospitalisation rates by socioeconomic status, Victoria, Australia

This paper analyses variations in heart failure (HF) hospitalisation rates by community socioeconomic status (SES) in Victoria,from 1 July 2011 to 30 June 2014. The data was taken from the Victorian Admitted Episodes Dataset, the Australian Bureauof Statistics’ Estimated Resident Population and Index of Relative Socioeconomic Disadvantage and the Victorian PopulationHealth Survey. There were over 38,000 HF hospitalisations over the period. The age-standardised HF rates per 10,000 populationvaried inversely (r = -0.362, p&lt;.01) with SES across 79 Local Government Areas (LGA). The coefficient of variation for HFhospitalisation rates was 0.35 and 0.14 for all admissions, indicating that HF hospitalisations have a greater variation by LGA.Communities with high HF rates also had high rates of current smokers (r = 0.24), chronic obstructive pulmonary disease (r= 0.57), renal failure (r = 0.54), diabetes (r = 0.24), musculoskeletal malignant neoplasms (r = 0.35) and Disability SupportPension recipients (r = 0.38). The average 30-day HF readmission rate was 25.5%, the second highest of all admission categories.The HF readmission rates also varied inversely (r = -0.38, p&lt;.01) with SES. Investigating variations in HF by SES may uncovermodifiable pathways. Given the high readmission rates, comorbidities and population ageing, there is a case for improving healthoutcomes for HF patients.

Timing of Diuretic Administration and Length of Stay in Patients with Acute Decompensated Heart Failure

Background: Heart failure (HF) is a major financial burden in the United States. Due to penalties in reimbursement for hospitals with high 30-day HF readmission rates and early follow-up after discharge has been shown to be an important factor in reducing readmission rates, we established a Nurse Practitioner managed, Heart Failure Bridge Clinic (HFBC). To evaluate the efficacy of the clinic, we reviewed the

Nurse Practitioner Run Heart Failure Bridge Clinic Reduces Readmission Rates

Background: Heart failure (HF) is a major financial burden in the United States. Due to penalties in reimbursement for hospitals with high 30-day HF readmission rates and early follow-up after discharge has been shown to be an important factor in reducing readmission rates, we established a Nurse Practitioner managed, Heart Failure Bridge Clinic (HFBC). To evaluate the efficacy of the clinic, we reviewed the

Implementing a pharmacy resident run transition of care service for heart failure patients: Effect on readmission rates.

Heart failure (HF) is a leading cause of hospital readmissions adversely affecting resources and hospital reimbursements. The purpose of this study was to optimize medication therapy, provide patient education and facilitate discharge and follow-up through the creation of a pharmacy resident managed HF transition service with the intention of decreasing readmission rates. A 6-month prospective, single center pilot study was conducted by a pharmacy resident to decrease readmission rates in patients with HF. Patients were identified through emergency department admission reports and direct requests from discharge nurses. The pharmacy resident provided patients with tailored medication and disease state counseling, ensured obtainment of discharge medications and performed follow up telephone calls for appointment reminders and further counseling. The primary outcome measured was readmission rate at 30 days. Secondary outcomes were number of patients requesting safety net medications, reason for readmission(s), and appointment compliance. Thirty patients were enrolled in the program. The 30-day heart failure readmission rate decreased from 28.1% to 16.6%. Eighty-eight percent of patients attended their follow up appointments. A reduction in readmission rate was achieved through this pharmacy resident-run HF transition service. The majority of patients attended follow-up visits and financial appointments after discharge.

Reducing Heart Failure Readmissions: A Clinical Business Analytics Approach

Reducing Heart Failure Readmissions: A Clinical Business Analytics Approach

First hospitalization for heart failure in France in 2009: Patient characteristics and 30-day follow-up

The incidence of heart failure (HF) is stable in industrialized countries, but its prevalence continues to increase, especially due to the ageing of the population, and mortality remains high. To estimate the incidence in France and describe the management and short-term outcome of patients hospitalized for HF for the first time. The study population comprised French national health insurance general scheme beneficiaries (77% of the French population) hospitalized in 2009 with a principal diagnosis of HF after exclusion of those hospitalized for HF between 2006 and 2008 or with a chronic disease status for HF. Data were collected from the national health insurance information system (SNIIRAM). A total of 69,958 patients (mean age 78 years; 48% men) were included. The incidence of first hospitalization for HF was 0.14% (≥ 55 years, 0.5%; ≥ 90 years, 3.1%). Compared with controls without HF, patients more frequently presented cardiovascular or other co-morbidities. The hospital mortality rate was 6.4% and the mortality rate during the 30 days after discharge was 4.4% (3.4% without readmission). Among 30-day survivors, all-cause and HF 30-day readmission rates were 18% (< 70 years, 22%; ≥ 90 years, 13%) and 5%, respectively. Reimbursements among 30-day survivors comprised at least a beta-blocker in 54% of cases, diuretics in 85%, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in 67%, a diuretic and ACEI/ARB combination in 23% and a beta-blocker, ACEI/ARB and diuretic combination in 37%. Patients admitted for HF presented high rates of co-morbidity, readmission and death at 30 days, and there remains room for improvement in their drug treatments; these findings indicate the need for improvement in return-home and therapeutic education programmes.

Heart Failure 30-Day Readmission Rates Are Associated with Nurse-Patient Ratios

Heart Failure 30-Day Readmission Rates Are Associated with Nurse-Patient Ratios