Reduce Heart Failure Readmissions Research Articles

The impact of a cardio-geriatric integrated care on mortality and readmissions in older patients with Heart Failure. Results of a quasi-experimental study

Abstract Background Despite advancements in heart failure (HF) management, older adults still experience adverse outcomes. Post-discharge care for frail elders is often complicated by non-cardiac events and Hospital-Acquired Deconditioning Syndrome. While an integrated multidisciplinary approach combining cardiological and geriatric expertise appears highly beneficial, it remains underutilized. Purpose To evaluate the effectiveness of an integrated Cardio-Geriatric approach in improving one-year mortality, reducing HF readmissions and increasing days-alive-out-of-hospital (DAOH) among older patients discharged from acute care hospitals. Methods The study utilized a before-and-after design. The study enrolled two groups of patients: the first consisted of individuals aged ≥ 65 years hospitalized for acute HF between January 2018 and December 2019, receiving usual care (UC) post-discharge follow-up (referral to a cardiologist and general practitioner); the second group evaluated outpatients in the Cardio-Geriatric ambulatory clinic (CG) within three weeks after discharge for acute HF between January 2020 and December 2022. Primary outcomes included one-year all-cause mortality, HF readmissions and DOAH. Cox Regression analysis adjusted for age, sex, frailty status, and main comorbidities assessed CG effectiveness. Results Among 606 patients (mean age 86 years, 56% females), 477 received US, the remaining 175 were referred to the CG. At 1-year follow-up we observed a significant reduction in re-hospitalizations between CG and UC (36.5% vs. 53.6%; respectively, p < 0.001) and mortality (20% vs. 44.8%; respectively, p < 0.001). CG patients had more than double DAOH (300 ± 100 vs 156 ± 145 days, p <0.001). Cox regression analysis confirmed CG integrated approach as a protective factor for mortality or re-hospitalization even after adjustment for confounders [aHR 0.50; 95% CI (0.28-0.89)]. Respiratory diseases, neurological conditions, and infections were common causes of readmission, emphasizing the need for comprehensive post-discharge care. Conclusion The Cardio-Geriatric integrated approach significantly improved outcomes, highlighting the potential of integrated care in addressing the multifaceted needs of older adults with heart failure

Abstract We107: Reduction of Six-Month Heart Failure Readmission Rates in Patients Undergoing MitraClip with Beta Receptor Blockade

Introduction: MitraClip has been shown to reduce heart failure readmissions in patients with moderate to severe mitral valve regurgitation. Likewise, beta-blocker (BB) therapy has been shown to reduce morbidity and mortality in select heart failure patients. At the cellular level, chronic myocardial insult from ongoing heart failure and mitral regurgitation leads to persistent overstimulation of myocardial beta-receptors, ultimately reducing cardiac inotropic reserve and contributing to myocardial injury. Thus, we hypothesized that patients on beta-blocker therapy before the MitraClip procedure would have fewer heart failure-related readmissions. Hypothesis: We assessed the hypothesis that beta-blocker therapy before the MitraClip procedure would lead to fewer heart failure-related readmissions by conducting a retrospective cohort study. This would help us better understand the pathogenesis of re-admissions in this patient population as well as help us decide whether prophylactic initiation of BB therapy before the procedure would reduce the risk of heart failure readmissions. Methods: We reviewed the records of patients who underwent the MitraClip procedure at our institution from January 2017 to July 2022. Patients without listed home medications, as well as non-heart failure-related readmissions and deaths, were excluded. Patients were split into those on BB therapy and those with no BB therapy. Of the 401 charts screened, 324 met the inclusion criteria. Results: From those who met the inclusion criteria, 226 patients were on beta-blocker therapy, while 98 patients were not. Of those who had at least one heart failure-related readmission within 6 months of the MitraClip procedure, 18 patients were on beta-blocker therapy and 16 patients were not. Meaning a 7.96% readmission rate for patients on beta-blocker therapy, and a 16.32% readmission rate for those who were not (OR 2.05, 95% CI: 1.004 to 4.186, p<0.05), with the number needed to treat being 11.9. Conclusions: Our data shows that the use of beta-blocker therapy was associated with a statistically significant decrease in 6-month heart failure readmissions in those undergoing the MitraClip procedure. This suggests that at the cellular level, cardiac beta receptor dysfunction plays an integral part in future hospitalizations in this population. In conclusion, beta-blocker therapy should be considered in heart failure patients planning to undergo the MitraClip procedure to reduce heart failure-related readmissions.

Point of Care Ultrasound (POCUS) in the Management of Heart Failure: A Narrative Review.

Assessing for volume overload is a key component of both short and long-term management of heart failure patients. Physical examination findings are neither sensitive nor specific for detecting congestion, and subclinical congestion may not be evident at the time of examination. Point of care ultrasound (POCUS) is an efficient and non-invasive way to assess heart failure patients for volume overload. The aim of our narrative review is to summarize how each of the following ultrasound modalities can be used to assess for congestion in the heart failure population: 2D and Doppler echocardiography, lung ultrasound, inferior vena cava ultrasound, internal jugular vein ultrasound, and venous excess grading. While each of these modalities has their limitations, their use in the acute and outpatient space offers the potential to reduce heart failure readmissions and mortality.

Randomised pilot study comparing a coach to SMARTPhone reminders to aid the management of heart failure (HF) patients: humans or machines

Ambulatory management of congestive heart failure (HF) continues to be a challenging clinical problem. Recent studies have focused on the role of HF clinics, nurse practitioners and disease management programmes...

Abstract P155: Identifying Inpatient and Outpatient Factors That Reduce Heart Failure Exacerbation Readmissions

Acute heart failure 30-day readmissions are associated with increased patient morbidity and mortality. Our aim is to identify systemic factors that can reduce heart failure readmissions, including the implementation of a heart failure care coordination team. We assessed the hypothesis that individualized post-discharge education and summary from the heart failure care coordination team will reduce 30-day heart failure readmissions.This retrospective study included 213 patients, 18 years and older admitted with NYHA Class II-IV and ACC/AHA Stage B-D heart failure exacerbations from July 2021- March 2022, at a community hospital. Collected variables included demographics, medical comorbidities, labs, echocardiographic findings, inpatient orders, LACE index score, discharge follow-up, receipt of an after-visit summary, length of stay, and 30-day readmission. Descriptive data was summarized as counts and percentages for categorical data, and mean or median for continuous data. Between-group parametric data means were compared by calculating the t-test for independent variables, or medians using the Mann-Whitney U test for data that were nonparametric. Categorical variables were compared by calculating the chi-square test for association or Fisher’s exact test, as appropriate. The primary study objective was tested using Logistic regression modeling. Throughout this study, a p-value ≤0.05 (two-tail) was considered statistically significant. The medical records of all available reduced treatment plan patients were compared to preserved treatment plan patients in approximately equal numbers. Pair-wise t-tests required the greatest number of subjects. Using the conventional power level of 80%, a two-tailed alpha of 0.05, and assuming a medium effect size, it was estimated that this comparison will require at least 114 subjects. In this study, 189 of 213 patients were reached by the heart failure care coordination team. 49/189 were readmitted in 30 days and 140/189 were not. For the readmission group, the percentage of patients who were CKD Stage 3 or 4 (39.4%, 28 of 71) was higher than those who were not (21.1%, 30 of 142) with a p-value of 0.005. The percentage of patients who had discharge BNP checked (39.1%, 18 of 46) was higher than those who were not (24.1%, 40 of 166) with a p-value of 0.043. A higher LACE index score was associated with readmission as compared to a lower score, with a p-value of < 0.001. In conclusion, presence of CKD stage 3 or 4, discharge BNP, and a higher LACE-index score were associated with 30-day heart failure readmission. Counterintuitively, the heart failure care coordination team did not have an impact on this endpoint, contrary to our hypothesis. Future studies with a larger sample size and focus on the outpatient care team efforts may be helpful in elucidating the team's potential in preventing heart failure readmission.

Integrating the American Heart Association's Clinical Decision Tool to Reduce Heart Failure Readmissions in an Academic Acute Care Hospital

Integrating the American Heart Association's Clinical Decision Tool to Reduce Heart Failure Readmissions in an Academic Acute Care Hospital

Heart Failure Readmissions: A Deep Dive into Patient Demographics, Comorbidities, and Systemic Challenges

Background: Heart failure (HF) is a leading cause of hospital readmissions, presenting significant challenges in healthcare. Comorbid conditions like diabetes and hypertension are prevalent among HF patients and may complicate disease management. Understanding these dynamics is crucial for developing effective intervention strategies. Objective: This study aims to analyze the factors contributing to HF readmissions, focusing on patient demographics, comorbidities, and systemic healthcare challenges. Methods: A comprehensive, retrospective cohort analysis was conducted at a tertiary care cardiac center. The study included 1,000 patients with a documented history of HF and instances of hospital readmissions. Patient selection was based on age (≥18 years), a diagnosis of HF, and readmission within six months post-discharge. Exclusion criteria included planned readmissions for elective procedures and cognitive impairments impeding consent. Data collection encompassed patient demographics, clinical history, comorbidity details, initial hospitalization, and readmission information. Descriptive statistics were employed to analyze and summarize the data. Results: The cohort comprised 80% male (n=800) and 20% female (n=200) with a mean age of 58 years. The median hospital stay was 6 days. Comorbidities included diabetes (78%, n=780) and hypertension (56%, n=560). The primary cause of HF was ischemic cardiomyopathy (82%, n=820). The leading reasons for readmission were lack of counseling (42%, n=420), underdosage of medication (16%, n=160), and non-compliance to medication (13%, n=130). Other factors included volume overload (11%, n=110), secondary hypertensive failure (9%, n=90), infections (6%, n=60), anemia (2%, n=20), and progressive renal failure (1%, n=10). Conclusion: The study highlights the complexity of managing HF, emphasizing the need for comprehensive approaches addressing patient education, medication management, and comorbidity control. Improved patient counseling and adherence to treatment regimens could significantly reduce HF readmissions.

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.

Meta Analysis of Interventions to Reduce Heart Failure Readmission

Meta Analysis of Interventions to Reduce Heart Failure Readmission

The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience.

The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF). The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients. Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate. A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)]. By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.

Effect of Glucagon-like Peptide-1 Receptor Agonists on Prognosis of Heart Failure and Cardiac Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Whether an antidiabetic drug, glucagon-like peptide-1 receptor agonist (GLP-1RA), could improve the prognosis of heart failure and cardiac function remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials to explore the influence of GLP-1RAs on heart failure in patients regardless of diabetes diagnosis. Literature in English from the PubMed, EMBASE, and Cochrane Library databases was searched from inception to July 2022. The study aim was to identify published, randomized, placebo-controlled trials testing GLP-1RAs in patients with or without diabetes. Outcomes were heart failure hospitalization, cardiac function, and structure measures. Twenty-two randomized controlled trials involving 61,412 patients are included in the meta-analysis. Overall, compared with the placebo group, GLP-1RA treatment could not significantly decrease heart failure hospitalization in patients with a history of heart failure (hazard ratio [HR], 1.07; 95% CI, 0.91 to 1.25; P=0.422). Six-minute walking test distances (WMD, 19.08 m; 95% CI, 4.81 to 33.36; P=0.01), E-wave (SMD, -0.40; 95% CI, -0.60 to -0.20; P < 0.001), early diastolic to late diastolic velocities ratio (WMD, -0.10; 95% CI, -0.18 to -0.02; P=0.01), mitral inflow E velocity to tissue Doppler e' ratio (WMD, -0.97; 95% CI, -1.54 to -0.41; P < 0.001), and E-wave deceleration time (WMD, -9.96 milliseconds; 95% CI, -18.52 to -1.41; P=0.02) increased significantly after administration of GLP-1RAs. However, GLP-1RAs do not significantly influence N-terminal pro-B-type natriuretic peptide levels (WMD, -20.02 pg/mL; 95% CI, -53.12 to 13.08; P=0.24), Minnesota Living with Heart Failure Questionnaire quality of life scores (WMD, -1.08; 95% CI, -3.99 to 1.84; P=0.47), or left ventricular ejection fractions (WMD, -0.37%; 95% CI, -1.19 to 0.46; P=0.38). GLP-1RAs did not reduce heart failure readmissions in patients with a history of heart failure and elevated N-terminal pro-B-type natriuretic peptide levels. Thus, the prognosis of heart failure was not improved, although GLP-1RAs did significantly improve left ventricular diastolic function in patients. PROSPERO identifier: CRD42021226231.

Proportion, Precipitators and Prognostic Marker of 30-Day Heart Failure Readmission at MOI Teaching and Referral Hospital, Eldoret, Kenya

Background: Heart failure (HF) affects 26 million people globally. It is associated with a high 30-day readmission rate due to multiple cardiovascular and non-cardiovascular precipitants. Readmissions are associated with high mortality, which may be predicted by pre-discharge N-terminal pro brain natriuretic peptide (NT-proBNP). There is no data on HF readmission rates, its precipitators and use of NT-proBNP as a prognostic marker at Moi Teaching and Referral Hospital (MTRH) in Western Kenya. Objective: To determine the 30-day proportion of HF readmission, the precipitators of HF and the association between NT-proBNP and 30 days’ readmission. Methods:This was a six-month prospective cohort study where we carried out a census and recruited adult participants admitted with HF at Moi Teaching and Referral Hospital. At discharge from hospital, an interviewer administered questionnaire was administered and blood samples for NT-proBNP drawn. Upon readmission, precipitators for HF were identified and compliance to therapy assessed using European heart failure Self Care Behavioral Scale. Continuous variables were summarized using median and IQR, categorical variables using frequencies and percentages. Associations were determined using Chi square, Fishers exact and Wilcoxon rank test. A p-value of &lt;0.05 was considered statistically significant. Results: From April to November 2018, 94 participants were recruited into the study; with median age 48 years (IQR 31,70), 58 (62%) were female, 35 (38%) consumed alcohol and 25(25%) smoked. Hypertension was the commonest comorbidity 20 (21%) while cardiomyopathy was the underlying etiology for HF in 58 (63%). HF with reduced Ejection Fraction (HFrEF) was present in 76% of the participants while 24% had HF with preserved Ejection Fraction (HFpEF). Sixty percent of the participants had NT-proBNP levels of &gt;4137 pg/ml, which implied poor prognosis. Of 17 readmitted patients, 12 participants (12.8%) were readmitted within 30 days at MTRH. Six (6.4%) participants were lost to follow up. Median time to readmission was 14 days, (IQR 7, 26). Pneumonia (55%) was the commonest precipitator of HF readmissions, followed by arrhythmias (atrial fibrillation) in 5 (42%), anemia 4 (33%), noncompliance 4 (33%), acute kidney injury 2 (16.6%) and no identified precipitator 1 (8.3%). There was no association between NT-proBNP and readmission (p =0.584) or NT-pro BNP and survival (p=0.773). Readmission was associated with a high mortality (p=0.008) with 50% of readmitted participants dying during the readmission period. The total mortality of both readmitted and non-readmitted participants was 16% at the end of the 6 months’ study period. Conclusions:In this cohort of participants with HF the proportion of 30 days readmission was high. Infections, mainly pneumonia was the commonest precipitator of readmission. Discharge NT-proBNP did not predict likelihood of 30 days’ readmission. Mortality was higher among participants readmitted within 30 days. Recommendations: Measures like pneumoccal vaccinations should be implemented to prevent pneumonia. Early appointments to cardiac clinic (less than 2 weeks post discharge) should be given to screen for precipitators and reduce HF readmissions. A follow up study to assess % change in NT pro BNP in relation to 30 days readmission.

Systolic Heart Failure and Optimization of Medical Therapy: A Quality Improvement Study

Introduction: Congestive heart failure (CHF) accounts for significant medical costs and patient mortality. There are ways to mitigate these parameters by providing patient and provider education, optimizing medications, and applying life-saving devices with a referral for a left ventricular assist device (LVAD) when appropriate. We retrospectively observed the charts of 40 patients at our Dayton Veterans Affairs Medical Center (VAMC) for areas of improvement. Methods: Charts were manually reviewed over 2019 for ejection fraction (EF) at the time of diagnosis and ischemic cardiomyopathy (ICM) vs. nonischemic cardiomyopathy (NICM) etiology of heart failure. Information on the titration of beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), and advanced heart failure medications was collected. Readmission rates and heart failure follow-up appointment rates were gathered, and further details were investigated regarding the application of a life vest and automatic implantable cardioverter-defibrillator (AICD) when clinically appropriate. Results: Median EF for patients was 34%, consistent with systolic heart failure. 65% of patients had ICM. For medications, BB was maximally titrated for 85% of patients within a wide data range. ACE-I/ARBs titration was appropriate in 75% of patients. An average of 4.7 dose adjustments for BB and 3.6 dose adjustments for ACE-I/ARBs occurred. Advanced CHF medications were rarely prescribed. Exacerbation rates were 60%, from 1–5 readmissions and an average of 1.07 readmissions. 98% of patients received CHF-specific follow-up after each CHF admission. 60% were eligible for advanced life support devices, 25% were offered life vests, and 62% were offered AICD. No patient was referred to a tertiary center for LVAD. Conclusion: We should work towards 100% medication titration to improve outcomes, especially BB which is known to have morbidity value. We can continue to reduce heart failure readmission rates by providing patient and provider education and continuing to do well at heart failure follow-up appointments. Life vest and AICD should be offered more consistently, and tertiary referral to receive LVAD should remain offered per standard of care.

Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials.

Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure. However, studies have produced conflicting outcomes over the years. To determine the aggregate effect of telemonitoring on all-cause mortality, heart failure-related mortality, all-cause hospitalization, and heart failure-related hospitalization in heart failure patients. We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients. We also conducted a sensitivity analysis to examine the effect of telemonitoring duration, recent heart failure hospitalization, and age on telemonitoring outcomes. Our study demonstrated that home telemonitoring in heart failure patients was associated with reduced all-cause [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.75-0.92, P = 0.001] and cardiovascular mortality (RR = 0.66, 95%CI: 0.54-0.81, P < 0.001). Additionally, telemonitoring decreased the all-cause hospitalization (RR = 0.87, 95%CI: 0.80-0.94, P = 0.002) but did not decrease heart failure-related hospitalization (RR = 0.88, 95%CI: 0.77-1.01, P = 0.066). However, prolonged home telemonitoring (12 mo or more) was associated with both decreased all-cause and heart failure hospitalization, unlike shorter duration (6 mo or less) telemonitoring. Home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients. In addition, prolonged telemonitoring (≥ 12 mo) reduces all-cause and heart failure-related hospitalization. The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.

Abstract 13786: Effectiveness of Ambulatory Pulmonary Artery Pressure-Guided Therapy in Reducing Readmissions in Patients With Heart Failure With Reduced Ejection Fraction versus Heart Failure With Preserved Ejection Fraction

Introduction: The cardio-microelectromechanical system (CardioMEMS) is an implantable pulmonary artery pressure monitoring device that aims to avoid decompensated heart failure (HF) admissions through hemodynamic-guided care. The aim of our study was to compare the impact of CardioMEMS implantation on hospital readmissions between HFrEF and HFpEF patients. Methods: Data from the National Readmission Database 2015 to 2019 were analyzed. International Classification of Diseases codes were used to identify patients hospitalized for HF and those with CardioMEMS implantation. The outcome of interest was the 30-day readmission rate. Multivariate logistic regression analysis was done to account for possible confounders. Results: We identified 3,801,661 admissions with a primary diagnosis of HF. Of these, 2,279,203 (59.95%) patients carried a diagnosis of HFrEF, while 1,522,458 (40.05%) had HFpEF. Patient characteristics are shown in the table. CardioMEMS was implanted in 1100 patients with HFrEF, and 297 patients with HFpEF. Among patients with HFrEF, those who received CardioMEMS implantation during the index admission had a significantly lower 30-day readmission rate compared to those who did not (16.4% vs 21.0%, adjusted odds ratio [OR] 0.74, 95% confidence interval [CI] 0.63-0.87, p &lt;0.01) (Figure). However, among HFpEF patients, there was no significant reduction in 30-day readmissions after CardioMEMS implantation (19.8% vs 20.7%, adjusted OR 0.95, 95% CI 0.72-1.27, p = 0.37) (Figure). CardioMEMS implantation was not associated with a higher rate of complications such as major bleeding, acute kidney injury, or stroke, in both HFrEF and HFpEF groups. Conclusions: Our findings suggest that ambulatory pulmonary artery pressure-guided therapy may be more effective in reducing HF readmissions in patients with HFrEF than in those with HFpEF. This may have significant clinical implication in appropriate patient selection for CardioMEMS implantation.

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.

Reducing Heart Failure Readmissions: Combining Clinical Assessment and Technology

Reducing Heart Failure Readmissions: Combining Clinical Assessment and Technology

Predictive Model for Heart Failure Readmission Using Nationwide Readmissions Database.

ObjectiveTo generate a heart failure (HF) readmission prediction model using the Nationwide Readmissions Database to guide management and reduce HF readmissions.Patients and MethodsA retrospective analysis was performed for patients listed for HF admissions in the Nationwide Readmissions Database from January 1, 2010, to December 31, 2014. A Cox proportional hazards model for sample survey data for the prediction of readmission for all patients with HF was implemented using a derivation cohort (2010-2012). We generated receiver operating characteristic (ROC) curves and estimated area under the ROC curve at each time point (30, 60, 90, and 180 days) to assess the accuracy of our predictive model using the derivation cohort (2010-2012) and compared it with the validation cohort (2013-2014). A risk score was computed for the validation cohort. On the basis of the total risk score, we calculated the probability of readmission at 30, 60, 90, and 180 days.ResultsApproximately 1,420,564 patients were admitted for HF, contributing to 1,817,735 total HF admissions. Of these, 665,867 patients had at least 1 readmission for HF. The 10 most common comorbidities for readmitted patients included hypertension, diabetes mellitus, renal failure, chronic pulmonary disease, deficiency anemia, fluid and electrolyte disorders, obesity, hypothyroidism, peripheral vascular disorders, and depression. The area under the ROC curve for the prediction model was 0.58 in the derivation cohort and 0.59 in the validation cohort.ConclusionThe prediction model will find clinical utility at point of care in optimizing the management of patients with HF and reducing HF readmissions.

Outcomes Of Remote Pulmonary Artery Hemodynamic Monitoring In Heart Failure Patients With Atrial Fibrillation In Male And Female Population

Introduction Pulmonary artery (PA) hemodynamic monitoring using CadioMEMS device has shown to decrease heart failure (HF) readmissions. Atrial fibrillation (AFib) and HF often coexist and AFib can itself cause variations in PA pressures. We studied the impact of remote PA hemodynamic monitoring in reducing HF readmissions in patients with Afib and HF in male and female population. Method Retrospective data was collected for patients with HF who had CardioMEMS device implanted based on FDA indications from April 2015 to August 2020. Data including number of all cause and HF hospitalizations, emergency department (ED) and HF clinic visits was collected for 1-year pre and 1-year post device implantation. Mortality data was collected at 1-year post-implantation. Analysis was done using the median and Kruskal-Wallis test for comparison between different age groups. Mortality was compared using Pearson's chi-squared test. Results CardioMEMS device was implanted in 177 patients during the study period. Of this population, 107 (60%) had AFib. There was a statistically significant decrease in overall mean HF admissions in Afib patients from 1.68 (± 1.34) to 0.63 (± 1.08), (63.1%) p<0.001 and mean HF ED visits 1.38 (± 1.40) to 0.57 (± 1.02), (58.7%) p<0.001 between 1-year pre and post implantation. But there was no statistically significant difference between male and female population in all-cause admissions, HF admissions, ED visits, ED HF visits, HF clinic visits along with mortality at 1-year post-implantation. Conclusion Remote PA hemodynamic monitoring decreases heart failure readmissions and ED visits in patients with AFib and HF and outcomes are similar in male and female population. Pulmonary artery (PA) hemodynamic monitoring using CadioMEMS device has shown to decrease heart failure (HF) readmissions. Atrial fibrillation (AFib) and HF often coexist and AFib can itself cause variations in PA pressures. We studied the impact of remote PA hemodynamic monitoring in reducing HF readmissions in patients with Afib and HF in male and female population. Retrospective data was collected for patients with HF who had CardioMEMS device implanted based on FDA indications from April 2015 to August 2020. Data including number of all cause and HF hospitalizations, emergency department (ED) and HF clinic visits was collected for 1-year pre and 1-year post device implantation. Mortality data was collected at 1-year post-implantation. Analysis was done using the median and Kruskal-Wallis test for comparison between different age groups. Mortality was compared using Pearson's chi-squared test. CardioMEMS device was implanted in 177 patients during the study period. Of this population, 107 (60%) had AFib. There was a statistically significant decrease in overall mean HF admissions in Afib patients from 1.68 (± 1.34) to 0.63 (± 1.08), (63.1%) p<0.001 and mean HF ED visits 1.38 (± 1.40) to 0.57 (± 1.02), (58.7%) p<0.001 between 1-year pre and post implantation. But there was no statistically significant difference between male and female population in all-cause admissions, HF admissions, ED visits, ED HF visits, HF clinic visits along with mortality at 1-year post-implantation. Remote PA hemodynamic monitoring decreases heart failure readmissions and ED visits in patients with AFib and HF and outcomes are similar in male and female population.

Using Personalized Text Messages To Improve Heart Failure Hospital Readmission Rates

<h3>Purpose</h3> Would personalized text messages to patients after heart failure hospitalizations help reduce readmission? <h3>Background</h3> Patients with managed Medicare and some private insurances have triggers for an established telephonic hospital follow up within the health system. But patients with managed Medicaid, "straight" Medicare (part A and B only), and some patients under 65 with private insurance do not have formal follow up by the health system entity after discharge. Through system indicator reports, patients were identified who did not have a following agency. As the phone contacts began, a trend emerged that a phone call was not always an effective way to reach patients. It was hypothesized that a personalized text message might make a better connection with patients after discharge to mitigate transition of care issues and in turn decrease readmission risk. Heart Failure team members have met with the patients during the hospital stay and had established some rapport already. <h3>Method</h3> Patients received a call from the Heart Failure Program, but if the patient was not reached, a text message was sent to their phone. The text message included a personalized message specific to what was discussed during their heart failure education visit while in the hospital. <h3>Results</h3> : There were 29 patients identified and texted from June to December 2020. 86% were male and 14% were female with ethnic breakdown of 66% white, 28% Hispanic/Latino, 3% Asian, 3% Middle Eastern. The mean age was 53 years old. Six patients (21%) of 29 texted replied back to text or called directly to the program office to speak to the Heart Failure Coordinator. Three (10%) patients texted instantly returned calls to program office after text was delivered. There were no 30-day readmissions for the 29 patients. <h3>Conclusion/Discussion</h3> Personalized texting appeared to help reduce heart failure readmissions with this group of patients that did not have other formal entities following hospitalization. The group observed was small, but it is beneficial when even one or two patients can be navigated away from the acute care setting. Additionally, although there wasn't a high number of direct responses, the chances of patients seeing the text were still high. A message with content that is simple and personalized may have been a helpful reminder of engagement of some level of heart failure self-care. The text message may also have served as a reminder that there was a reasonably easy way to communicate with a member of the care team without navigating through the healthcare call center. The quick replies that were received appeared to be prompted by an urgent need for help connecting with their primary provider or with problems related to medications. The text messages further highlighted structural problems patients encounter after discharge, specifically medication disruptions and physician follow up. These identified problems helped direct further readmission reduction work.