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Prevention of readmission in elderly patients with congestive heart failure

Results of a prospective, randomized pilot study

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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.

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Received from the Geriatric Cardiology Section, Division of Cardiology, Jewish Hospital at Washington University Medical Center, St. Louis, Missouri.

Supported by a Community Research Grant-in-Aid from the American Heart Association, Missouri Affiliate.

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Rich, M.W., Vinson, J.M., Sperry, J.C. et al. Prevention of readmission in elderly patients with congestive heart failure. J Gen Intern Med 8, 585–590 (1993).

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