Strategies to Reduce 30-Day Readmissions in Older Patients Hospitalized with Heart Failure and Acute Myocardial Infarction

Abstract

Readmission within 30 days after hospital discharge for common cardiovascular conditions such as heart failure and acute myocardial infarction is extremely common among older persons. To incentivize investment in reducing preventable rehospitalizations, the United States federal government has directed increasing financial penalties to hospitals with higher-than-expected 30-day readmission rates. Uncertainty exists, however, regarding the best approaches to reducing these adverse outcomes. In this review, we summarize the literature on predictors of 30-day readmission, the utility of risk prediction models, and strategies to reduce short-term readmission after hospitalization for heart failure and acute myocardial infarction. We report that few variables have been found to consistently predict the occurrence of 30-day readmission and that risk prediction models lack strong discriminative ability. We additionally report that the literature on interventions to reduce 30-day rehospitalization has significant limitations due to heterogeneity, susceptibility to bias, and lack of reporting on important contextual factors and details of program implementation. New information is characterizing the period after hospitalization as a time of high generalized risk, which has been termed the post-hospital syndrome. This framework for characterizing inherent post-discharge instability suggests new approaches to reducing readmissions.

Impact of Post-Hospital Syndrome on Outcomes Following Elective, Ambulatory Surgery

“…Efforts to promote patient well-being during and after inpatient hospitalization should be emphasized to improve patients' physiological reserve, possibly through greater attention to sleep, nutrition, activity levels, and careful symptom management. 1,16 Since elective surgery should be associated with minimal morbidity and mortality, using lessons from high-risk elective surgery (eg, prehabilitation, standardized postoperative care pathways) may be a way to mitigate any increased risk found in PHS patients undergoing elective surgery. 17,18 …”

Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends

“…Although a number of predictive risk models are available, they lack robust discriminative capability and require further development and refinement. 33 Strategies such as community health workers and patient navigators are used to engage vulnerable populations. 34 The US Patient Protection and Affordable Care Act has increased the focus on decreasing hospital readmissions that are frequent, costly, and often preventable.…”

“…This phenomenon has been termed "posthospital syndrome" and emphasizes new approaches to reducing readmissions. 33 Because many readmissions are not attributable to the index admission condition, this new approach involves considering factors beyond the initial reason for hospitalization and contemplating other factors, including physiological and psychological issues. Moreover, empirically examining predictors of adverse health outcomes, such as renal dysfunction, is important.…”

Caracterização De Pacientes Reinternados No Setor De Cardiologia

“…Em outro estudo retrospectivo analítico (12) , no qual 99 pacientes foram submetidos à cirurgia cardíaca para revascularização do miocárdio, substituição de válvula cardíaca ou uma combinação de ambos, a média foi de 6 a 7 dias de hospitalização. As readmissões em 30 dias após a alta hospitalar decorrente de doenças cardiovasculares, como IC e IAM são comuns em idosos (13,10) . Em estudo conduzido na Itália, as causas mais comuns de readmissões foram relacionadas às doenças cardiovasculares e doenças pulmonares (14) , sendo pneumonia e infecção frequentemente apontados na literatura (15,5) .…”

“…Em 2012, como medida para diminuir reinternações evitáveis, o governo federal dos EUA começou a aplicar penalidades financeiras para hospitais com taxas de readmissão de 30 dias mais altas que o esperado para essas três condições. As referidas sanções aumentaram a cada ano, desde 2012 (13) . Em uma pesquisa realizada no Sul da Itália, identificou-se uma taxa de readmissão de 10,2% no prazo de 30 dias, sendo que alguns pacientes tiveram mais de uma reinternação nesse período.…”