The Prevention of Hospital Readmissions in Heart Failure

Ziaeian, Boback; Fonarow, Gregg C.

doi:10.1016/j.pcad.2015.09.004

Cited by 201 publications

(159 citation statements)

References 52 publications

(48 reference statements)

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“…There is an unfortunate gap in the literature regarding evidence‐based interventions to reduce readmissions following cardiac surgery . Early efforts to improve the management of CHF patients, based largely on improving care coordination, may provide a model for cardiac surgical patients . The Hospital to Home (H2H) Program, sponsored by The American College of Cardiology and Institute for Healthcare Improvement, was established to reduce readmission rates for heart failure patients and improve the transition to an outpatient setting by ensuring timely follow‐up, discharge medication management and patient education regarding recognition of signs and symptoms needing attention .…”

Section: Discussionmentioning

confidence: 99%

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

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Background Readmissions after cardiac surgery are common and associated with increased morbidity, mortality and cost of care. Policymakers have targeted coronary artery bypass grafting to achieve value‐oriented health care milestones. We explored the causes of readmission following cardiac surgery among a regional consortium of hospitals. Methods Using administrative data, we identified patients readmitted to the same institution within 30 days of cardiac surgery. We performed standardized review of readmitted patients’ medical records to identify primary and secondary causes of readmission. We evaluated causes of readmission by procedure and tested for univariate associations between characteristics of readmitted patients and nonreadmitted patients in our clinical registry. Results Of 2218 cardiac surgery patients, 272 were readmitted to the index hospital within 30 days for a readmission rate of 12.3%. Median time to readmission was 9 days (interquartile range 4‐16 days) and only 13% of patients were evaluated in‐office before readmission. Readmitted patients were more likely to have had valve surgery (31.3% vs 22.7%) than patients not readmitted. Readmitted patients were also more likely to have preoperative creatinine more than or equal to 2 mg/dL (P = .015) or congestive heart failure (CHF) (P = .034), require multiple blood transfusions or sustained inotropic support (P < .001), and experience postoperative atrial fibrillation (P = .022) or renal insufficiency (P < .001). Infection (26%), pleural or pericardial effusion (19%), arrhythmia (16%), and CHF (11%) were the most common primary etiologies leading to readmission. Conclusions Ensuring early follow‐up for high‐risk patient groups while improving early detection and management of the principal drivers of readmission represent promising targets for decreasing readmission rates.

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Section: Discussionmentioning

confidence: 99%

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

et al. 2019

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“…2 Of those readmissions, only 17% to 35% are for recurrent HF exacerbations. 32 Therefore, studies using the NIS are not able to distinguish a unique HF hospitalization from a HF readmission. The number of states that participated in the NIS in 2002 was 35 covering 87% of the United States population and it increased to 44 states covering 97% of the United States population by 2013.…”

Section: Discussionmentioning

confidence: 99%

National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity

Ziaeian

Kominski

Ong

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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162

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Background National heart failure (HF) hospitalization rates have not been appropriately age-standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. Methods and Results The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 U.S. standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100,000 between 2002 and 2013. While hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for males compared to females increased from 20% greater to 39% (p-for-trend=0.002) between 2002 and 2013. Black males had a rate that was 229% (p-for-trend=0.141) and black females 240% (p-for-trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic males had a rate that was 32% greater in 2002 and the difference narrowed to 4% (p-for-trend=0.047) greater in 2013 relative to whites. For Hispanic females the rate was 55% greater in 2002 and narrowed to 8% greater (p-for-trend=0.004) in 2013 relative to whites. Asian/Pacific Islander (PI) males had a 27% lower rate in 2002 that improved to 43% (p-for-trend=0.040) lower in 2013 relative to whites. For Asian/PI females the hospitalization rate was 24% lower in 2002 and improved to 43% (p-for-trend=0.021) lower in 2013 relative to whites. Conclusions National HF hospitalization rates have decreased steadily over the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. The evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/PI are needed.

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“…Interventions to improve posthospital outcomes in patients with heart failure (HF) have traditionally focused on hospital discharge . Although skilled nursing facilities (SNFs) are often used to transition vulnerable patients from hospital to home, it is increasingly recognized that the additional transitions from hospital to SNF and then from SNF to home can affect readmission risk.…”

mentioning

confidence: 99%

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

Weerahandi

Bao

Herrin

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. Here, we examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization. DESIGN Retrospective cohort study. SETTING Fee‐for‐service Medicare data, 2012 to 2015. PARTICIPANTS Beneficiaries, aged 65 years and older, hospitalized with HF who were subsequently discharged to SNF and then discharged home. MEASUREMENTS The primary outcome was unplanned readmission within 30 days of discharge to home from SNF. We compared time to readmission between those with and without HHC services using a Cox model. RESULTS Of 67 585 HF hospitalizations discharged to SNFs and subsequently discharged home, 13 257 (19.6%) were discharged with HHC, and 54 328 (80.4%) were discharged without HHC. Patients discharged home from SNFs with HHC had lower 30‐day readmission rates than patients discharged without HHC (22.8% vs 24.5%; P < .0001) and a longer time to readmission. In an adjusted model, the hazard for readmission was 0.91 (0.86‐0.95) with receipt of HHC. CONCLUSIONS Recipients of HHC were less likely to be readmitted within 30 days vs those discharged home without HHC. This is unexpected, as patients discharged with HHC likely have more functional impairments. Since patients requiring a SNF stay after hospital discharge may have additional needs, they may particularly benefit from restorative therapy through HHC; however, only approximately 20% received such services. J Am Geriatr Soc 68:96–102, 2019

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The Prevention of Hospital Readmissions in Heart Failure

Cited by 201 publications

References 52 publications

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity

Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization

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