Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative

Nair, Raunak; Lak, Hassan Talebi; Hasan, Somar; Gunasekaran, Deepthi; Babar, Arslan; Gopalakrishna, K. V.

doi:10.7759/cureus.7420

Cited by 18 publications

(21 citation statements)

References 18 publications

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“…Also, studies have shown significantly reduced all-cause mortality with more frequent vital sign measurements (more than twice a week). All-cause hospitalization rates and heart failure-related hospitalization rates are critical health economic indicators of patient discharge, transfer and post-discharge follow-up outcomes, and are helpful in assessing the prognosis of patients with CHF ( 33 ). The results of this study found that the e-health intervention group was able to significantly reduce all-cause hospitalization and heart failure-related hospitalization rates, with statistically significant differences.…”

Section: Discussionmentioning

confidence: 99%

Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis

Ding

Wen

Tian

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveThe aim of this meta-analysis was to assess the impact of e-health interventions on disease management in patients with CHF.MethodsSix databases including Embase, Web of Science, Scopus, PubMed, Cochrane, and EBSCO were searched by computer. The search time is before May 1, 2022. Odds ratios (OR) were used for binary categorical data and weighted mean differences (WMD) for continuous variables. The 95% confidence intervals (CI) were used to express the effect sizes for both count and measurement data. RevMan 5.4 and Stata 16.0 were employed to complete this meta-analysis.ResultsThe study included 22 research studies and 5,149 patients. e-health intervention can effectively reduce all-cause mortality [OR = 0.801, 95%CI: (0.650, 0.987), P < 0.05], all-cause hospitalization rate [OR = 0.66, 95%CI: (0.46, 0.95), P < 0.05] and heart failure related hospitalization rate [OR = 0.750, 95%CI: (0.632, 0.891), P < 0.05]. e-health intervention is also effective in improving the quality of life [WMD = 2.97, 95%CI: (1.54, 4.40), P < 0.05] and the self-management ability of patients [WMD = −2.76, 95%CI: (−5.52, −0.11), P < 0.05].Conclusione-health interventions can reduce all-cause mortality, all-cause hospitalization, and heart failure-related hospitalization in patients with CHF. Furthermore, it can improve the health-related quality of life of patients.

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Section: Discussionmentioning

confidence: 99%

Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis

Ding

Wen

Tian

et al. 2023

Front. Cardiovasc. Med.

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“…Our intervention incorporated elements that were informed by the PHCRP such as enhanced education on the evidence basis for reducing CHF readmissions [27][28][29][30] . Our work supports AHA guidelines recommending that CHF patients undergo routine SDOH screening 31 .…”

Section: Discussionmentioning

confidence: 99%

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

et al. 2023

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Background Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. Objective To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. Methods We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. Results There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p =0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p =0.005; 55.7% vs. 42.3%, p =0.0029), but no improvement in appointment attendance. Conclusion This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08086-7.

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“…Further research should focus on those pharmacologic, social, and lifestyle interventions that would decrease these rates, including ensuring scheduled followup appointments and patient education that have been shown to be effective for reducing the risk of being readmitted to the hospital during the first month after hospital discharge for acute myocardial infarction. 29…”

Section: Acute Clinical Complications Associated With Hospital Readmissionmentioning

confidence: 99%

Temporal Trends and Patient Characteristics Associated with 30-Day Hospital Readmission Rates after a First Acute Myocardial Infarction

Tisminetzky

Mehawej

Miozzo

et al. 2021

The American Journal of Medicine

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BACKGROUND: Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are re-hospitalized after hospital admission for an acute myocardial infarction. This study examined trends in the frequency and sociodemographic and clinical characteristics of patients readmitted to the hospital within 30 days after an initial acute myocardial infarction. METHODS: We reviewed the medical records of 3116 individuals who were hospitalized for a validated first acute myocardial infarction in 6 study periods between 2003 and 2015 at the 3 major medical centers in central Massachusetts. RESULTS:The median age of our population was 67 years, and 42% were women. The risk of being readmitted to the hospital within 30 days after an initial acute myocardial infarction increased slightly during the most recent study years after controlling for potentially confounding factors. Overall, older adults and patients with previously diagnosed atrial fibrillation, heart failure, diabetes, chronic kidney disease, stroke, and peripheral vascular disease were at higher risk for being readmitted to the hospital than respective comparison groups. For those hospitalized in the most recent study years of 2011/2015, a higher risk of rehospitalization was associated with a previous diagnosis of chronic kidney disease, peripheral vascular disease, the presence of 3 or more chronic conditions, and having developed atrial fibrillation or heart failure during the patient's hospitalization for a first acute myocardial infarction. CONCLUSIONS: We identified several groups at higher risk for hospital readmission in whom enhanced surveillance efforts as well as tailored educational and treatment approaches remain needed.

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Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative

Cited by 18 publications

References 18 publications

Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis

Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

Temporal Trends and Patient Characteristics Associated with 30-Day Hospital Readmission Rates after a First Acute Myocardial Infarction

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