Prevention of readmission in elderly patients with congestive heart failure
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective: To determine the feasibility and potential impact of a non-pharmacologic multidisciplinary intervention for reducing hospital readmissions in elderly patients with congestive heart failure.
Design: Prospective, randomized clinical trial, with 2:1 assignment to the study intervention or usual care.
Setting: 550-bed secondary and tertiary care university teaching hospital.
Patients and participants: 98 patients ≥70 years of age (mean 79±6 years) admitted with documented congestive heart failure.
Interventions: Comprehensive multidisciplinary treatment strategy consisting of intensive teaching by a geriatric cardiac nurse, a detailed review of medications by a geriatric cardiologist with specific recommendations designed to improve medication compliance and reduce side effects, early consultation with social services to facilitate discharge planning, dietary teaching by a hospital dietician, and close follow-up after discharge by home care and the study team.
Measurements and main results: All patients were followed for 90 days after initial hospital discharge. The primary study endpoints were rehospitalization within the 90-day interval and the cumulative number of days hospitalized during follow-up. The 90-day readmission rate was 33.3% (21.7%–44.9%) for the patients receiving the study intervention (n=63) compared with 45.7% (29.2–62.2%) for the control patients (n=35). The mean number of days hospitalized was 4.3±1.1 (2.1–6.5) for the treated patients vs. 5.7±2.0 (1.8–9.6) for the usual-care patients. In a prospectively defined subgroup of patients at intermediate risk for readmission (n=61), readmissions were reduced by 42.2% (from 47.6% to 27.5%; p=0.10), and the average number of hospital days during follow-up decreased from 6.7±32 days to 3.2±1.2 days (p=NS).
Conclusions: These pilot data suggest that a comprehensive, multidisciplinary approach to reducing repetitive hospitalizations in elderly patients with congestive heart failure may lead to a reduction in readmissions and hospital days, particularly in patients at moderate risk for early rehospitalization. Further evaluation of this treatment strategy, including an assessment of the cost-effectiveness, is warranted.
- Gooding J, Jette AM. Hospital readmissions among the elderly. J Am Geriatr Soc. 1985;33:595–601.
- Rich MW, Freedland KE. Effect of Dregs on three-month readmission rate of geriatric patients with congestive heart failure. Am J Public Health. 1988;78:680–2.
- Vinson JM, Rich MW, Shah AS, Sperry JC. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990;38:1290–5.
- Graham H, Livesley B. Can readmissions to a geriatric unit be prevented? Lancet. 1983;1:404–6. CrossRef
- Campion EW, Jette AM, Berkman B. An interdisciplinary geriatric consultation service: a controlled trial. J Am Geriatr Soc. 1983;31:792–6.
- Andrews K. Relevance of readmission of elderly patients discharged from a geriatric unit. J Am Geriatr Soc. 1986;34:5–11.
- Kennedy L, Neidlinger S, Scroggins K. Effective comprehensive discharge planning for hospitalized elderly. Gerontologist. 1987;27:577–80.
- Townsend J, Piper M, Frank AO, Dyer S, North WRS, Meade TW. Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomized controlled trial. BMJ. 1988;297:544–7. CrossRef
- Smith DM, Weinberger M, Katz BP, Moore PS. Postdischarge care and readmissions. Med Care. 1988;26:699–708. CrossRef
- Weinberger M, Smith DM, Katz BP, Moore PS. The cost-effectiveness of intensive postdischarge care: a randomized trial. Med Care. 1988;26:1092–102. CrossRef
- Rich MW, Sperry JC, Vinson JM, Shah AS. Prediction of readmission of elderly patients with congestive heart failure [abstr]. Boston: Proceedings of the American Geriatrics Society 46th Annual Meeting, 1989;56.
- Anderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984;311:1349–53. CrossRef
- Zook CJ, Moore FD. High cost users of medical care. N Engl J Med. 1980;302:996–1002. CrossRef
- Lemrow N, Adams D, Coffey R, Farley D. The 50 most frequent diagnosis-related groups (DRGs), diagnoses, and procedures: statistics by hospital size and location. Rockville, MD: Agency for Health Care Policy and Research. DHHS Publication No. 90-3465;1990:1–12.
- Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973-1986. Evidence for increasing population prevalence. Arch Intern Med. 1990;150:769–73. CrossRef
- Furberg CD, Yusuf S, Thom TJ. Potential for altering the natural history of congestive heart failure: need for large clinical trials. Am J Cardiol. 1985;55:45A-47A. CrossRef
- Ghali JK, Kadakia S, Cooper R, Ferlinz J. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med. 1988;148:2013–16. CrossRef
- Graves EJ. 1989 Summary: National Hospital Discharge Survey. Advance data from Vital and Health Statistics 1991;No. 199:1–12.
- Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.
- Folstein MF, Folstein SE, McHugh PF. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. CrossRef
- Prevention of readmission in elderly patients with congestive heart failure
Journal of General Internal Medicine
Volume 8, Issue 11 , pp 585-590
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- hospital readmissions
- heart failure, congestive
- cost containment
- Industry Sectors