Irish Journal of Medical Science

, Volume 178, Issue 2, pp 167–171 | Cite as

Can we reduce preventable heart failure readmissions in patients enrolled in a Disease Management Programme?

  • D. Phelan
  • L. Smyth
  • M. Ryder
  • N. Murphy
  • C. O’Loughlin
  • C. Conlon
  • M. Ledwidge
  • K. McDonaldEmail author
Original Article



Disease Management Programmes (DMPs) are successful in reducing hospital readmissions in heart failure (HF). However, there remain a number of patients enrolled in a DMP who are readmitted with HF. The primary aim of the study was to determine the proportion of preventable readmissions (PR). The secondary aim was to recognise patient characteristics which would identify certain patients at risk of having a PR.


A retrospective chart search was performed on patients readmitted over a 1-year period.


38.5% of readmissions were classified as PR. None of these patients made prior contact with the DMP. Admission levels of BNP, potassium, urea and creatinine were significantly lower in the PR group.


DMP have proven benefits in reducing hospital readmission nonetheless a significant proportion of these readmissions are preventable. Further work is required to prospectively analyse why these patients fail to contact the DMP.


Disease Management Programme Heart failure Preventable and unavoidable readmissions 



The Authors would like to thank the Heartbeat Trust and Health Research Board for financial support.


  1. 1.
    Swedberg K, Cleland J, Dargie H et al (2005) Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 26(11):1115–1140PubMedCrossRefGoogle Scholar
  2. 2.
    Jong P, Vowinckel E, Liu PP et al (2002) Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 162(15):1689–1694PubMedCrossRefGoogle Scholar
  3. 3.
    MacIntyre K, Capewell S, Stewart S et al (2000) Evidence of improving prognosis in heart failure: trends in case fatality in 66,547 patients hospitalized between 1986 and 1995. Circulation 102(10):1126–1131PubMedGoogle Scholar
  4. 4.
    The Task Force on Heart Failure of the European Society of Cardiology (1995) Guidelines for the diagnosis of heart failure. Eur Heart J 16(6):741–751Google Scholar
  5. 5.
    Ho KK, Anderson KM, Kannel WB et al (1993) Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 88(1):107–115PubMedGoogle Scholar
  6. 6.
    Krumholz HM, Chen YT, Wang Y et al (2000) Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J 139(1 Pt 1):72–77PubMedCrossRefGoogle Scholar
  7. 7.
    Rich MW (1999) Heart failure disease management: a critical review. J Card Fail 5(1):64–75PubMedCrossRefGoogle Scholar
  8. 8.
    Stewart S, Jenkins A, Buchan S et al (2002) The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 4(3):361–371PubMedCrossRefGoogle Scholar
  9. 9.
    Stewart S (2005) Financial aspects of heart failure programs of care. Eur J Heart Fail 7(3):423–428PubMedCrossRefGoogle Scholar
  10. 10.
    Ledwidge M, Barry M, Cahill J et al (2003) Is multidisciplinary care of heart failure cost-beneficial when combined with optimal medical care? Eur J Heart Fail 5(3):381–389PubMedCrossRefGoogle Scholar
  11. 11.
    Komajda M, Follath F, Swedberg K et al (2003) The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 24(5):464–474PubMedCrossRefGoogle Scholar
  12. 12.
    Drechsler K, Dietz R, Klein H et al (2005) Euro heart failure survey. Medical treatment not in line with current guidelines. Z Kardiol 94(8):510–515PubMedCrossRefGoogle Scholar
  13. 13.
    Bassand JP, Hamm CW, Ardissino D et al (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 28(13):1598–1660PubMedCrossRefGoogle Scholar
  14. 14.
    Michalsen A, Konig G, Thimme W (1998) Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 80(5):437–441PubMedGoogle Scholar
  15. 15.
    Wagdi P, Vuilliomenet A, Kaufmann U et al (1993) Inadequate treatment compliance, patient information and drug prescription as causes for emergency hospitalization of patients with chronic heart failure. Schweiz Med Wochenschr 123(4):108–112PubMedGoogle Scholar
  16. 16.
    Ghali JK, Kadakia S, Cooper R et al (1988) Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med 148(9):2013–2016PubMedCrossRefGoogle Scholar
  17. 17.
    Gonseth J, Guallar-Castillon P, Banegas JR et al (2004) The effectiveness of Disease Management Programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J 25(18):1570–1595PubMedCrossRefGoogle Scholar
  18. 18.
    Del Sindaco D, Pulignano G, Minardi G et al (2007) Two-year outcome of a prospective, controlled study of a Disease Management Programme for elderly patients with heart failure. J Cardiovasc Med (Hagerstown) 8(5):324–329Google Scholar
  19. 19.
    McDonald K, Ledwidge M, Cahill J et al (2002) Heart failure management: multidisciplinary care has intrinsic benefit above the optimization of medical care. J Card Fail 8(3):142–148PubMedCrossRefGoogle Scholar
  20. 20.
    McDonald K, Ledwidge M, Cahill J et al (2001) Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge. Eur J Heart Fail 3(2):209–215PubMedCrossRefGoogle Scholar
  21. 21.
    Chung ML, Moser DK, Lennie TA et al (2006) Gender differences in adherence to the sodium-restricted diet in patients with heart failure. J Card Fail 12(8):628–634PubMedCrossRefGoogle Scholar
  22. 22.
    Conlon C, Ledwidge M, McDonald K (2006) Community direct access service for early detection and treatment of clinical deterioration: effectiveness and impact on the workload pattern of a hospital-based heart failure unit. Dis Manage Health Outcomes 14(3):185–190CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2009

Authors and Affiliations

  • D. Phelan
    • 1
  • L. Smyth
    • 1
  • M. Ryder
    • 1
  • N. Murphy
    • 1
  • C. O’Loughlin
    • 1
  • C. Conlon
    • 1
  • M. Ledwidge
    • 1
  • K. McDonald
    • 1
    Email author
  1. 1.Heart Failure UnitSt Vincent’s University HospitalDublin 4Ireland

Personalised recommendations