Postdischarge Assessment After a Heart Failure Hospitalization

Metra, Marco; Gheorghiade, Mihai; Bonow, Robert O.; Dei, Livio

doi:10.1161/circulationaha.110.982207

Cited by 71 publications

(54 citation statements)

References 22 publications

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“…Selected high-risk patients may benefit from an early postdischarge visit that can facilitate detection and treatment of these abnormalities. 20 Even though the study by Chen et al suggests that rates of HF hospitalization may have declined in recent years, the overall mortality rate and readmission rate for HF continue to remain unacceptably high. New approaches for patients hospitalized for HF must be developed and implemented.…”

Section: Augment Use Of Underused Agents Known To Improvementioning

confidence: 99%

Hospitalizations for Heart Failure in the United States—A Sign of Hope

Gheorghiade¹,

Braunwald²

2011

JAMA

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EART FAILURE (HF) IS THE MOST COMMON CAUSE OF hospitalization in patients older than 65 years in the United States. 1 In the early 1990s, data from clinical trials and registries demonstrated that in patients hospitalized with HF, mortality and rehospitalization rates could be as high as 15% and 30%, respectively, at 60 to 90 days after discharge.2,3 During this period, major efforts were directed toward reducing the length of stay in patients hospitalized with HF.4 Performance measures were developed and later adopted by the Centers for Medicare & Medicaid Services (CMS) with the intent to improve postdischarge outcomes.5 Although these measures were implemented across the country, the rehospitalization rate for patients with HF did not appear to decrease. 4,6 Recently, because of changes in CMS reimbursement patterns, the focus has shifted toward 30-day postdischarge readmission rates as a measure of care.In this issue of JAMA, Chen et al 7 reviewed administrative data of more than 55 million Medicare fee-for-service beneficiaries, with a mean age of 79 years, who were hospitalized with a discharge diagnosis of HF. Black patients represented 11% of the total study population. The overall rates of risk-adjusted hospitalization for HF declined 30% over the study period from 2845 per 100 000 person-years in 1998 to 2007 per 100 000 person-years in 2008. The authors attribute this decline in hospitalizations to reductions in the incidence of coronary artery disease, improved control of blood pressure, increased use of evidence-based therapies, and possibly changes in admission thresholds. In contrast to this significant reduction in hospitalizations for HF, 1-year risk-adjusted all-cause mortality rate declined minimally but remained high at approximately 30%.This report is a substantial contribution to existing HF epidemiological literature because it is the first to document an improvement in hospitalization rates in HF in the United States. These improvements appear to be more evident in recent years during which major progress has been made in promoting evidence-based therapies for coronary artery disease. However, this substantial decline in hospitalization rates was significantly less in black men than in white men. Another important observation was that the decreases in hospitalization rates across states were not uniform. The authors also noted that comorbidities such as hypertension and renal dysfunction increased over time. Approximately 40% of these patients had diabetes and 30% had chronic obstructive pulmonary disease.The general reduction in admission rates may reflect improvements in overall management of HF risk factors, as suggested by Chen et al, 7 but the persistently high 1-year mortality rates suggest that postdischarge practices for patients with HF have not been as effective. Although the admission rates for HF have decreased based on Medicare data reported by Chen et al, the available data suggest that rehospitalization rates after an index admission for HF have remained unchanged or have ev...

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Section: Augment Use Of Underused Agents Known To Improvementioning

confidence: 99%

Hospitalizations for Heart Failure in the United States—A Sign of Hope

Gheorghiade¹,

Braunwald²

2011

JAMA

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“…It is also important to coordinate regional collaboration with primary physician and care services in rural settings [21, 25, 26]. Our program recommended follow-up with cardiovascular specialists after discharge.…”

Section: Discussionmentioning

confidence: 99%

“…However, there was no significant increase in the rate of this follow-up after the introduction of our program because of the limited cardiovascular health resources in this rural setting. Therefore, collaborative care with a primary physician (non-cardiologist) is required particularly for HF patients in rural areas [25, 26]. Social support is also important for such patients [27].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting

Kinugasa

Kato

Sugihara

et al. 2014

BMC Health Serv Res

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BackgroundHeart failure (HF) patients living in rural areas have a lack of HF knowledge and poor self-care because of limited medical care access. Multidisciplinary education to improve self-care behavior is indispensable for such patients. The present study evaluated whether intensive inpatient education improved outcomes of hospitalized HF patients in a Japanese rural setting.MethodsAn inpatient HF management program based on multidisciplinary team intervention was applied to hospitalized HF patients in a Japanese rural area. We defined patients treated within the program from May 2009 to April 2011 as the intervention group (n = 144), and those treated with the usual care from May 2006 to April 2009 as the usual care group (n = 133). The composite endpoints of HF hospitalization and all-cause mortality were compared between the two groups.ResultsCompared with patients in the usual care group, those in the intervention group more often received the optimal interventions such as discharge use of β-blockers, cardiac rehabilitation, pre-discharge diagnostic tests, and multidisciplinary intensive education including nurse-led patient education, pharmacist’s medication teaching, and dietitian’s nutritional guidance (all P < 0.05). The incidence of the composite endpoints significantly decreased after introducing the program (P < 0.001). Among a number of interventions, multidisciplinary intensive education was the most effective intervention to improve the primary outcome (P < 0.001).ConclusionsMultidisciplinary intensive education is a key strategy for helping improve the outcome for Japanese HF patients in a rural setting. Our data may give a positive impact on the improvement of healthcare system in Japan.

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“…Early post-discharge follow-up visits have been suggested to reduce post-discharge re-hospitalization rates [8]. However, whom and what to target during the early postdischarge period beyond guideline recommended therapy is not well known [16,17]. Much of the data regarding post-discharge events has come from administrative datasets or large registries [1,3,13,14], both of which lack detailed clinical, laboratory, and neurohormonal data at pre-specified follow-up intervals after discharge.…”

Section: \0001mentioning

confidence: 99%

A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial

et al. 2011

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Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF ≤40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later (>90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization.

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Postdischarge Assessment After a Heart Failure Hospitalization

Cited by 71 publications

References 22 publications

Hospitalizations for Heart Failure in the United States—A Sign of Hope

Hospitalizations for Heart Failure in the United States—A Sign of Hope

Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting

A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial

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