Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?

Abstract

Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.

Effect of early physician follow-up on mortality and subsequent hospital admissions after emergency care for heart failure: a retrospective cohort study

“…10 Potential systems-level solutions include care by nurse practitioners, physician assistants and transitional care clinics. 45 Telemedicine is an option of increasing interest for follow-up of patients in remote areas. Health insurance is one of the most important predictors of obtaining follow-up care; 46,47 therefore, in the US, outcomes will likely be affected by the future of the Affordable Care Act.…”

Plasma biomarkers to predict or rule out early post‐discharge events after hospitalization for acute heart failure

“…Development and effective implementation of such strategies requires tools that can accurately identify low‐risk patients that can be safely discharged and treated less aggressively post‐discharge and high‐risk patients for whom more intensive in‐hospital and post‐discharge management is justified. Nevertheless, prediction of post‐discharge events, particularly readmissions, with readily available clinical variables and standard laboratory parameters remains challenging . Biomarkers can play an essential role in improving objective pre‐discharge risk stratification and several promising prognostic biomarkers are currently available in AHF thanks to significant advances in proteomic research over recent years .…”

“…Several strategies have been proposed to reduce the enormous burden of early post‐discharge events on patients and health care systems . Several observational data suggested that longer hospital stay and intensified post‐discharge care are among the strategies that can be potentially beneficial in terms of lowering 30‐day readmission rates .…”

“…Effective implementation of this strategy requires tools that can accurately identify subpopulations of patients at low or high risk of early post‐discharge events. Nonetheless, prediction of these events, hospital readmissions in particular, remains a significant clinical challenge …”

The Effects of Group Education With the Teach-Back Method on Hospital Readmission Rates of Heart Failure Patients

“…A survey done in Iran found that 25% of patients hospitalized in heart wards are suffering from heart failure (4). Elderly patients with heart failure are also at increased risk for early hospitalization, with rates of readmission ranging from 29 to 47% within three to six months of the initial discharge (2)(3)(4)(5).…”