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A Perspective on Recent Hospital Strategies to Reduce Heart Failure Readmissions and Improve Outcomes

  • Heart Failure Prevention (S. Joseph, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Heart failure is a complex and expensive disease that represents an increasing burden to the healthcare system. Regulatory changes that affect payments for inpatient care have influenced the way we practice medicine.

Recent Findings

Hospitals have struggled to employ strategies to improve publically reported metrics. Resources are available yet there is no clear recommendation on best practice. There is a debate whether the 30-day readmission metric represents favorable patient outcomes.

Summary

There will be continued debate on how to best define quality for heart failure care; provider engagement is necessary as pressures on healthcare value will certainly remain.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mozzafarian D, Benjamin EJ, Go AS, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e360.

  2. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Voigt J, Sasha John M, Taylor A, Krucoff M, Reynolds MR, Michael Gibson C. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States. Clin Cardiol. 2014;37(5):312–21.

    Article  PubMed  Google Scholar 

  4. Report to the Congress: Medicare and the Health Care Delivery System. 2013. Available from: http://www.medpac.gov/docs/default-source/reports/jun13_ch04.pdf?sfvrsn=0.

  5. Readmissions Reduction Program (HRRP) CMS.gov; 2016 [cited 2017 June 20]. Available from: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html.

  6. Acute Inpatient PPS: CMS.gov; 2017 [cited 2017 June 20]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/acuteinpatientpps/.

  7. Rau J. Medicare’s Readmission Penalties Hit New High [cited 2017 Jun 20]. Available from: http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/.

  8. Rau J. Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions [cited 2017 Jun 20]. Available from: http://khn.org/news/readmission-penalties-medicare-hospitals-year-two/.

  9. Fleming LM, Kociol RD. Interventions for heart failure readmissions: successes and failures. Curr Heart Fail Rep. 2014;11(2):178–87.

    Article  PubMed  Google Scholar 

  10. 30-day Measures Fact Sheet 2016 [cited 2017 Jun 16]. Available from: https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_467882.pdf.

  11. • Heidenreich PA, Hernandez AF, Yancy CW, Liang L, Peterson ED, Fonarow GC. Get With The Guidelines program participation, process of care, and outcome for Medicare patients hospitalized with heart failure. Circ Cardiovasc Qual Outcomes. 2012;5(1):37–43. This study provides evidence for the use of the GWTG-HF program to reduce 30-day readmissions. However, specific impactful interventions within the program have not been identified.

    Article  PubMed  Google Scholar 

  12. Kociol RD, Peterson ED, Hammill BG, Flynn KE, Heidenreich PA, Pina IL, et al. National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry. Circ Heart Fail. 2012;5(6):680–7.

    Article  PubMed  Google Scholar 

  13. Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: the importance of transitional care in achieving health reform. Health Aff (Millwood). 2011;30(4):746–54.

    Article  Google Scholar 

  14. Amarasingham R, Patel PC, Toto K, Nelson LL, Swanson TS, Moore BJ, et al. Allocating scarce resources in real-time to reduce heart failure readmissions: a prospective, controlled study. BMJ Qual Saf. 2013;22(12):998–1005.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Parkes J, Shepperd S. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2000;4:CD000313.

    Google Scholar 

  16. Whitaker-Brown CD, Woods SJ, Cornelius JB, Southard E, Gulati SK. Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic. Heart Lung. 2017;46(2):79–84.

    Article  PubMed  Google Scholar 

  17. • Pandey A, Golwala H, Xu H, DeVore AD, Matsouaka R, Pencina M, et al. Association of 30-day readmission metric for heart failure under the hospital readmissions reduction program with quality of care and outcomes. JACC Heart Fail. 2016;4(12):935–46. This retrospective analysis of GWTG-HF registry further questions the validity of the 30-day readmission measure as a marker for quality of care as 1-year mortality rates were lower in hospitals with excessive readmissions .

    Article  PubMed  Google Scholar 

  18. Kociol RD, Liang L, Hernandez AF, Curtis LH, Heidenreich PA, Yancy CW, et al. Are we targeting the right metric for heart failure? Comparison of hospital 30-day readmission rates and total episode of care inpatient days. Am Heart J. 2013;165(6):987–94 e1.

    Article  PubMed  Google Scholar 

  19. Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, Bohm M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation. 2011;123(17):1873–80.

    Article  PubMed  Google Scholar 

  20. •• Abraham WT, Adamson PB, Bourge RC, Aaron MF, Costanzo MR, Stevenson LW, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011;377(9766):658–66. The CardioMEMS device significantly reduced HF-related hospitalizations over the original study period of 6 months with continued reduction into the mean 15-month follow-up speaking to the long-term efficacy of this device to improve disease control.

    Article  PubMed  Google Scholar 

  21. Adamson PB, Abraham WT, Bauman J, Yadav J. Abstract 16744: impact of wireless pulmonary artery pressure monitoring on heart failure hospitalizations and all-cause 30-day readmissions in Medicare-eligible patients with NYHA class III heart failure: results from the CHAMPION trial. Circulation. 2014;130(Suppl 2): A16744-A.

  22. Vanoli E, D'Elia E, La Rovere MT, Gronda E. Remote heart function monitoring: role of the CardioMEMS HF system. J Cardiovasc Med (Hagerstown). 2016;17(7):518–23.

    Article  Google Scholar 

  23. Adamson PB, Abraham WT, Bourge RC, Costanzo MR, Hasan A, Yadav C, et al. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail. 2014;7(6):935–44.

    Article  PubMed  Google Scholar 

  24. Adamson PB, Abraham WT, Bourge RC, Lynne W, Stevenson LW, Yadav J. CardioMEMS heart sensor allows monitoring of pressures to improve outcomes in NYHA class III heart failure patients (CHAMPION) trial: impact of hemodynamic guided care on patients with preserved ejection fraction. J Card Fail. 2010;16:913.

    Google Scholar 

  25. Criner G, et al. Impact of wireless implanted pulmonary artery pressure monitoring system in heart failure patients with comorbid chronic obstructive pulmonary disease. Eur Respir J. 2012;40(Supplement 56):P9761.

    Google Scholar 

  26. Benza R, Bourge R, Adamson P, et al. Heart failure hospitalizations are reduced in heart failure patients with comorbid pulmonary hypertension using a wireless implanted pulmonary artery pressure monitoring system. J Card Fail. 2012;18(Supplement 8):S99.

    Article  Google Scholar 

  27. Abraham WT, et al. Benefits of Pulmonary Artery Pressure Monitoring in Patients with NYHA Class III Heart Failure and Chronic Kidney Disease: Results from the CHAMPION Trial. J Card Fail. 2014;20(Supplement S93).

  28. Strickland WL, et al. The utility of remote wireless pulmonary artery pressure monitoring in patients with or without a history of myocardial infarction: experience from the CHAMPION Trial. J Am Coll Cardiol. 2011;58(20 Supplement):B130.

    Google Scholar 

  29. Miller AB, et al. Impact of remote, wireless pulmonary artery hemodynamic monitoring in patients with atrial fibrillation and chronic heart failure: insights from the CHAMPION Trial. J Am Coll Cardiol. 2012;59(13 Supplement):E868.

    Article  Google Scholar 

  30. Desai AS, Bhimaraj A, Bharmi R, Jermyn R, Bhatt K, Shavelle D, et al. Reduction in heart failure hospitalizations with ambulatory hemodynamic monitoring seen in clinical trials is maintained in the ‘Real World’. J Am Coll Cardiol. 2017;

  31. Zuckerman RB, Sheingold SH, Orav EJ, Ruhter J, Epstein AM. Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374(16):1543–51.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA

    William J. Binder & Jennifer L. Cook

Authors
  1. William J. Binder
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  2. Jennifer L. Cook
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Corresponding author

Correspondence to Jennifer L. Cook.

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Conflict of Interest

Dr. Cook would like to disclose that she serves as principal investigator for CardioMEMS (Abbott) clinical research and her institution receives research funds. William Binder declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Additional information

This article is part of the Topical Collection on Heart Failure Prevention

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Binder, W.J., Cook, J.L. A Perspective on Recent Hospital Strategies to Reduce Heart Failure Readmissions and Improve Outcomes. Curr Cardiovasc Risk Rep 11, 33 (2017). https://doi.org/10.1007/s12170-017-0557-2

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  • DOI: https://doi.org/10.1007/s12170-017-0557-2

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