Hospital readmission in heart failure, a novel analysis of a longstanding problem
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Acute decompensated heart failure is a significant source of morbidity and mortality in the USA. It is the most common reason for admission in the Medicare population and the greatest cause of hospital readmission in both medical and surgical patients. As many of these readmissions are considered preventable, providers and hospital systems are seeking novel strategies to reduce rehospitalization. Several specific interventions have been shown to decrease readmission for heart failure. However, these are typically narrow in scope, focusing on one aspect of patient care and providing a one-size-fits-all approach. We review the data and propose integrating some of these interventions into a comprehensive patient-centered model that is organized into six categories: quality of medical management, early reassessment, health literacy, neuropsychological status, financial means and functional status. By screening for deficiencies in each of these categories, providers and hospital systems can use resources more efficiently to make targeted interventions to improve health outcomes and mitigate readmissions.
KeywordsHeart failure Patient readmission Health literacy Patient discharge Telemedicine Self care
We would like to thank Karen Mack and Cindy Bither for their assistance with the preparation of the manuscript.
Conflict of interest
The authors have no financial disclosures to report.
- 2.Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB et al (2012) Heart disease and stroke statistics–2012 update: a report from the American heart association. Circulation 3(125):e2–e220Google Scholar
- 4.Centers for Medicare and Medicaid Services (CMS), HHS (2013) Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Fed Regist 78(160):50495–51040Google Scholar
- 7.Patient Protection and Affordable Care Act (2010) Pub. L. NO. 111-148, §2702, 124. Stat 119:318–319Google Scholar
- 11.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 15(62):e147–e239CrossRefGoogle Scholar
- 14.Kociol RD, Horton JR, Fonarow GC, Reyes EM, Shaw LK, O’Connor CM et al (2011) Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) linked to Medicare claims. Circ Heart Fail 4:628–636CrossRefPubMedCentralPubMedGoogle Scholar
- 16.Goonewardena SN, Gemignani A, Ronan A, Vasaiwala S, Blair J, Brennan JM et al (2008) Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure. JACC Cardiovasc Imaging 1:595–601CrossRefPubMedGoogle Scholar
- 17.Fonarow GC, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH et al (2007) Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med 167:1493–1502CrossRefPubMedGoogle Scholar
- 20.Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K (2007) Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manag 33(3):238–246Google Scholar
- 30.Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, Böhm M et al (2011) 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 3(123):1873–1880CrossRefGoogle Scholar
- 35.Patel A, Parikh R, Howell E, Hsich E, Gorodeski E (2014) Mini-Cog performance: a novel marker of risk among patients hospitalized for heart failure. Poster presentation at challenges in acute decompensated heart failure. 64th annual american college of cardiology scientific sessions, Washington, DC, 29–31 March 2014.Google Scholar
- 50.O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD et al (2010) Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (sertraline against depression and heart disease in chronic heart failure) trial. J Am Coll Cardiol 56:692–699CrossRefPubMedCentralPubMedGoogle Scholar
- 51.Angermann CE, Gelbrich G, Störk S, Fallgatter A, Deckert J, Faller H et al (2007) Rationale and design of a randomised, controlled, multicenter trial investigating the effects of selective serotonin re-uptake inhibition on morbidity, mortality and mood in depressed heart failure patients (MOOD-HF). Eur J Heart Fail 9:1212–1222CrossRefPubMedGoogle Scholar
- 67.Yu DSF, Thompson DR, Lee DT (2006) Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. Eur Heart J 27(5):592–612Google Scholar