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Tackling Heart Failure Readmissions

Tackling Heart Failure Readmissions

According to recent estimates, heart failure (HF) currently affects about 6 million adults in the United States, and the prevalence is projected to increase 25% by 2030. When HF patients are hospitalized, it represents a turning point in the natural history of their disease. “About 25% of HF patients who are discharged from the hospital are readmitted within 30 days,” says Clyde W. Yancy, MD, MSc, FACC. HF patients often need to be readmitted because the underlying cause of HF worsens. Hospitalizations are responsible for the majority of the nearly $40 billion that is spent annually for HF care in the U.S. As a result, these hospitalizations have become a focal point for quality improvement efforts and initiatives aimed at reducing costs. In an effort to improve outcomes, CMS has mandated that hospitals report their 30-day readmission rates for HF and acute myocardial infarction (AMI). The problem with this approach, according to Dr. Yancy, is that public reporting of outcomes is not effective as a hospital performance indicator. “Readmission rates, particularly for HF, are not a good marker of quality of care,” he says. “The emphasis on 30-day readmissions is misguided because the primary driver of these events is often patient population and the community that is served by hospitals.” Clinical investigations have also suggested that public reporting does not provide effective incentives for improvement and has had only minor effects on outcomes. Widespread Concern The changing paradigm to deny payment for HF readmissions within 30 days of discharge has led to widespread concern across hospitals. “Implementing HF programs and readmission reduction strategies are undertakings that require significant analysis,...
Hospital Admission Risk Factors for Older HF Patients

Hospital Admission Risk Factors for Older HF Patients

The number of older people with heart failure (HF) has increased considerably over the past 20 years. Currently, 80% of patients with HF are 65 or older. The costs associated with HF are more than $35 billion per year in the United States, and these costs are largely driven by hospital stays. Yet, relatively little is known about the long-term risk for hospital admission after an HF diagnosis in older people. In addition, few data are available on the role that geriatric conditions—slow gait, muscle weakness, and cognitive impairment—play in driving HF hospitalizations. Addressing Heart Failure Knowledge Gaps My colleagues and I conducted a study in which we evaluated data from a population-based sample of people aged 65 and older who were followed for up to 20 years after being diagnosed with HF. Published in the Journal of the American College of Cardiology, the study sought to identify risk factors for lifetime hospital utilization after a new HF diagnosis and to identify risk factors for hospitalization.     Three geriatric conditions—muscle weakness, slow gait, and depression—emerged as independent risk factors for hospital admission after a diagnosis of HF, even after considering other traditional cardiovascular factors. Our analysis also found that depressed ejection fraction, New York Heart Association class III or IV symptoms, diabetes, and chronic kidney disease were other independent risk factors for admission after an HF diagnosis in older patients. Implications for Future Care After HF Diagnosis The prognostic information revealed by our study may be used to help with clinical decision making and to identify potential targets for interventions after an HF diagnosis in older patients. Muscle weakness,...
Examining Trends in HF Hospitalizations

Examining Trends in HF Hospitalizations

According to recent estimates, heart failure (HF) is one of the most common reasons for hospital admission in the United States. Efforts have been made to reduce the number of hospitalizations related to HF, and several therapies have been developed over the last 20 years that have been shown to reduce disease-related hospitalizations. Furthermore, quality improvement initiatives are being developed and launched to ensure the appropriate delivery of evidence-based therapies in HF. CMS has been reporting on the quality of care and rate of HF rehospitalization for hospitals in an effort to encourage quality improvement initiatives. “While previous analyses have shown that rates of HF hospitalizations increased in the 1980s and 1990s, more recent CMS data indicate that hospitalizations with a primary diagnosis of HF in the elderly declined over the last decade,” explains Saul B. Blecker, MD, MHS. “These findings have been attributed to improvements in treatment and reductions in prevalent HF. However, most hospitalizations involving these patients are for reasons other than acute HF.” Gaining Perspective on Secondary HF Hospitalizations Quality improvement initiatives typically target only hospitalizations with a primary diagnosis of HF. As a result, these initiatives may not affect comorbid conditions that are associated with HF but are not directly caused by it. “Characterizing trends in hospitalizations with HF as a primary or secondary diagnosis can help clinicians further understand and recognize the role of cardiac disease and non-cardiac conditions,” Dr. Blecker says. “It can also help educate future initiatives to improve quality improvement initiatives.” A study by Dr. Blecker and colleagues published in the Journal of the American College of Cardiology evaluated trends in...

Assessing Heart Failure Guideline Adherence

Duke University researchers suggest that less than one half (44%) of patients with heart failure (HF) and an ejection fraction of 45% or less receive all guideline-recommended therapies for their condition. Adherence to HF recommendations for using β-blockers, ACE inhibitors, angiotensin blockers, and anticoagulants were better than adherence to recommendations for using implantable cardioverter-defibrillators, cardiac resynchronization therapy, or aldosterone antagonists. Lower New York Heart Association functional class and care by a cardiologist were linked to better guideline adherence. Abstract: American Heart Journal, November...

Conference Highlights: ACC.12

New research was recently presented at ACC.12, the annual scientific meeting of the American College of Cardiology, from March 24-27 in Chicago. The features below highlight just some of the studies that emerged from the meeting. Angioplasty Safe at Community Hospitals Should LDL Be Targeted Early in Life? Improving BP Control With Telemedicine A Checklist to Reduce HF Readmissions Visualization Encourages Statin Adherence & Lifestyle Changes Improving the Quality of ACS Care Angioplasty Safe at Community Hospitals The Particulars: Community hospitals without cardiac surgery units have traditionally performed angioplasties only in emergency situations. Patients needing elective angioplasty have typically been transferred to hospitals with on-site cardiac surgery units. A recent guideline from the American College of Cardiology and American Heart Association questioned the need for such transfers. Data Breakdown: In a study, nearly 19,000 patients were randomized to undergo elective angioplasty at a facility with on-site cardiac surgery or at one of 60 community hospitals that had undergone special preparations to perform angioplasty. No differences were observed in death rates between the two facility types. Furthermore, no significant differences were seen in rates of complications, such as bleeding, renal failure, and stroke. Take Home Pearl: With appropriate preparation, community hospitals without on-site cardiac surgery units appear to have the capability to safely and effectively perform elective angioplasty. Should LDL Be Targeted Early in Life? The Particulars: Patients with high LDL cholesterol often do not begin treatment to lower their LDL levels until after coronary heart disease (CHD) has been quietly developing for years. Coronary atherosclerosis begins early in life. It has been hypothesized that lowering LDL at a younger...
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