Home-Based Nurse Practitioner Transition Of Care Providers Decrease Readmission Rate For Patients With Heart Failure

Background Acute heart failure (AHF) presents as either new-onset heart failure (de novo AHF) or acute decompensation of chronic heart failure (ADCHF). Studies comparing the detailed cardiac characteristics of these groups remain limited. Purpose We sought to identify clinical characteristics and compare mortality and AHF readmission outcomes in patients with de novo AHF and ADCHF. Methods In a prospective, two-centre observational cohort study, adults hospitalised with clinical signs of AHF were enrolled from 2022 to 2024. Echocardiography, 8-zone lung ultrasound (LUS), and laboratory tests were performed shortly after admission. Medical chart reviews provided a detailed medical history at the time of admission. We analysed the composite outcome of AHF readmission or all-cause mortality at 90 and 180 days after discharge. Results A total of 567 patients admitted with AHF were prospectively included (mean age 78.2 ± 11.6; 43.7% female). Among these, 299 (52.7%) had de novo AHF and 268 (47.3%) had ADCHF. Compared to ADCHF, patients with de novo AHF were younger (77.1 ± 12.1 vs. 79.4 ± 10.8 years, p=0.020), had fewer comorbidities (Figure 1), including a lower prevalence of atrial fibrillation (57.5% vs. 72.8%, p<0.001), and were more likely to present with acute coronary syndrome as AHF aetiology (19.4% vs. 6.0%, p<0.001). On echocardiography, patients with ADCHF had higher filling pressures (E/e’: 18.0 ± 8.69 vs. 15.5 ± 8.17, p=0.002), larger left atrial volume index (41.6 ± 18.4 vs. 36.2 ± 15.2 mL/m2, p=0.005), and lower tricuspid annular plane systolic excursion (1.81 ± 0.39 vs. 1.89 ± 0.35 cm, p=0.023). There was no significant difference in left ventricular ejection fraction between groups (ADCHF: 37.8% vs. de novo AHF: 37.4%, p=0.749). On LUS, patients with ADCHF presented with a higher B-line count compared to patients with de novo AHF (10 ± 9 vs. 7 ± 8, p<0.001). At 90- and 180-days post-discharge, 140 (24.7%) and 185 (32.6%) patients were either readmitted with AHF or died. Although 90-day outcome rates were comparable (de novo AHF: 21.7% vs. ADCHF: 28.0%, p=0.10), patients with ADCHF had worse 180-day outcomes (38.4% vs. 27.4%, p=0.039). In univariable Cox regression, ADCHF was associated with a higher 180-day composite outcome risk (HR 1.51, 95% CI 1.13–2.02, p=0.005) (Figure 2). This association remained after adjusting for age and comorbidities (HR 1.45, 95% CI 1.05–1.99, p=0.022). Conclusions In this real-life prospective cohort of patients admitted with clinical signs of AHF, cases of de novo AHF and ADCHF were evenly distributed. Patients with de novo AHF tended to be younger, had fewer comorbidities, better diastolic and right ventricular function, and less pulmonary congestion on LUS. While short-term outcomes were similar, ADCHF patients had significantly higher 180-day readmission or mortality rates. ADCHF was independently associated with a higher risk of the 180-day composite outcome.Figure 1 Figure 2

A systematic review and meta-analysis on the association between quality of hospital care and readmission rates in patients with heart failure

Right Ventricular Infarction

P004. 30-Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Objective: To evaluate the effects of a community based chronic heart failure management program, delivered by nurse practitioners, on self-care behaviour, quality of life and hospital readmissions. Background: Chronic heart failure is a complex condition associated with high rates of hospital readmissions. However, many hospitalisations in patients with chronic heart failure are potentially preventable with better self-management and access to specialised healthcare support. Nurse practitioners have an advanced scope of practice, making them well credentialed to support patients with chronic heart failure. Study design and methods: This study compared self-care behaviour and quality of life in patients who had attended a nurse-practitioner led chronic heart failure management service (SmartHeart) (n=58) compared with patients receiving usual care (n=58), but no nurse practitioner support. Self-care behaviour was assessed using the Self Care Heart Failure Index and quality of life was assessed using the Short Form-36 and Minnesota Living with Heart Failure Questionnaire. Hospitalisation records were extracted from medical records using data-linkage. Results: Patients who received nurse-practitioner support had better self-care behaviour (p<0.05), mental component summary of the Short Form-36 (p<0.05) and heart failure specific quality of life (p<0.05). All-cause hospitalisations were delayed (p<0.05) and length of stay was shorter (p<0.05) in the group receiving nurse practitioner support, but there were no differences in chronic heart failure related admissions. Discussion: A chronic heart failure support program, operating in a community setting and delivered by nurse practitioners, enhanced self-care, improved psychosocial health and reduced time in hospital. Conclusion: Chronic heart failure management delivered by nurse practitioners can improve self-care behaviour and quality of life, and reduced hospital admissions, compared with usual care. What is already known about the topic? Chronic heart failure is a complex health issue requiring disease-specific management that needs to be tailored to the individual. However, many patients with chronic heart failure don’t receive adequate support to manage their condition. What does this paper add: A chronic heart failure management service, delivered in primary care by nurse practitioners, improved self-management and quality of life and was associated with a lower rate of hospitalisations compared with usual care alone.

<p style="text-align: justify;"><strong>Background: </strong>Patients with type II diabetes are at major risk for cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have demonstrated benefit for these patients. The purpose of this study is to determine whether SGLT-2 inhibitors significantly reduce heart failure readmission rates and improve outcomes in patients with congestive heart failure (CHF). <strong>Methods:</strong> Patient data was pulled on CHF patients with an active prescription for an SGLT-2 inhibitor, and it was analyzed using Fischer&rsquo;s Exact tests and two-tailed t-tests. The primary outcome was a 6-month hospital readmission rate due to CHF while taking SGLT-2 inhibitors. Secondary outcomes included 6-month all-cause hospital readmissions, renal function as measured by an estimated glomerular filtration rate change between admissions, mortality rates, and ejection fraction. <strong>Results: </strong>Of the 138 patients that met inclusion criteria for the first admission, the 6-month all-cause readmission rate for CHF patients still taking SGLT-2 inhibitors at readmission was 21 percent vs 16 percent (<em>p</em>=0.6) for the control group not taking SGLT-2 inhibitors. The 6-month CHF readmission rate in patients taking SGLT-2 inhibitors was 7.2 percent, and a CHF specific readmission rate was not collected for the control group. In patients with an eGFR less than 90, the average eGFR for the SGLT-2 group declined slightly but was not significant between patients at first admission and those with readmission (<em>p</em>=0.21). <strong>Conclusion:</strong> The use of SGLT-2 inhibitors in patients with CHF did not change the overall hospital readmission rate; however, larger randomized controlled trials are needed for further evaluation of the potential benefit. <p style="text-align: justify;"><strong>Key words: </strong>Cardiovascular Outcomes, Chronic Heart Failure, Heart Failure Hospitalization, SGLT2 Inhibition, Type II Diabetes.

American Association of Heart Failure Nurses’ mission, vision, and strategic plan: What do these mean to me—the member?

Experience of a Newly Established Multidisciplinary Heart Failure Clinic at a VA Hospital

In recent years, public reporting, targeted financial penalties, and incentives to develop alternative payment models that include the assumption of financial risk have compelled hospitals to focus on reducing readmission rates for high-cost conditions such as heart failure (HF). When older patients with multiple medical conditions including HF are discharged from the hospital, they are vulnerable to adverse events, which may result in recurrent hospitalization (the post-hospital syndrome).1 In theory, providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. Within the United States, home health care (HHC) referrals after acute care hospitalization increased by 65% to 3.7 million between 2001 and 2012.2,3 Patients discharged from US hospitals with a primary diagnosis of HF had the highest number of HHC referrals during this time, with ≈200 000 post-acute HHC referrals in 2012.2 In addition, HHC surpassed skilled nursing facilities as the most frequently used post-acute care among Medicare beneficiaries with HF in 2012 (unpublished HCUPnet data). Such an increase in HHC use for patients with HF is likely related to multiple factors, including decreasing length of stay for patients with HF4 and more recent pressures to improve readmission rates for HF after adoption of the Affordable Care Act in 2010, which included the Hospital Readmissions Reduction Program that was implemented in 2012.5,6 Despite substantial growth in post-acute HHC referrals for patients with HF,2 it is unclear whether HHC delivered in real-world settings consistently provides high-value care. Understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care. Because most patients referred for skilled HHC are Medicare beneficiaries, Medicare eligibility and payment policies have important implications for HHC. Patients who …

Congestive heart failure with preserved systolic function in a statewide sample of community hospitals

Objectives The objectives of this study were to evaluate the effect of pharmacist discharge counselling on patient adherence to heart failure (HF) therapy among an elderly US population and assess hospital readmission rates. Methods A randomized prospective pilot study included patients 65 years or older, admitted with a new HF diagnosis or readmission for HF exacerbation. The intervention arm received HF counselling by the pharmacist, and the control group received regular discharge care provided by a nurse. Medication adherence was assessed using prescription refill history and the Morisky Medication Adherence Scale (MMAS-8) given during the phone call follow-up at days 3, 30, 60 and 90. Key findings A total of nine patients were included in the control group and seven patients in the intervention group. MMAS-8 scores increased in the intervention group and suggested higher adherence versus the control group; 7.5 versus 7.1 at day 3, 8 versus 5.5 at day 30 and 8 versus 7.6 at day 60. At day 90, MMAS-8 scores decreased in both the intervention group and control group respectively (6.5 versus 6.9). Prescription filling rates showed greater adherence in the intervention group compared with the control group at day 30 (100% versus 86%) and day 60 (100% versus 83%). There were less HF re-hospitalizations in the intervention group compared with the control group (0% versus 11%) at day 30 compared with day 60 (29% versus 11%). At day 90, no difference was found for the readmission rates between the groups. Conclusions Pharmacists providing counselling may improve medication adherence and decrease readmission rates in patients with HF in the first month after discharge. Improvement was not maintained in successive months. More frequent communication involving more than one follow-up phone call in a month may be needed to re-emphasize important counseling points.

Morbidity and Mortality of Congestive Heart Failure in Trauma Patients

Background: Current research and guidelines vary greatly on the ideal time for initial post-discharge follow-up for acute coronary syndrome (ACS) and congestive heart failure (CHF). BRIDGE is a nurse practitioner-delivered cardiac transitional care program for patients lacking primary care or cardiology follow-up at discharge. BRIDGE referrals are seen within 14 days of discharge. This study aimed to determine the ideal timeframe for initial post-discharge follow-up. Methods: Retrospective data from the BRIDGE registry were abstracted for ACS and CHF patients referred to BRIDGE and readmitted within 30 days. Patients were divided into 4 cohorts based on the number of days to readmission: Time (T)1=0-3 days, T2=4-7 days, T3=8-14 days, and T4=15-30 days. Readmissions were further classified as the same cardiac reason as index admission, “Different Cardiac” or “Non-Cardiac.” ACS and CHF readmissions were compared by time to readmission and reason for readmission . Results: Of 2367 patients (mean age 64.9, 58% male and 85.3% white), 733 patients had an admission for ACS and 548 for CHF. Regardless of BRIDGE attendance, 16.8% (n=123) of ACS patients and 25.4% (n= 139) of CHF patients and were readmitted within 30 days. The majority of readmissions within 30 days (ACS 62.6%, CHF 53.2%) were on or before the 14th day post-discharge. Nearly half of T1 readmissions (ACS=47.6%, CHF=55.6%) were for Non-Cardiac reasons. For all other timeframes, ACS patients had more readmissions for Different Cardiac reasons, and CHF patients more often were readmitted for CHF. In contrast to 30 day readmission rates for the entire population (16.8% and 25.4%), the 30-day readmission rate for ACS and CHF patients who attended their BRIDGE appointment was 6.4% and 15.4% respectively . Conclusions: For both CHF and ACS patients, greater than 50% of readmissions occurred before 14 days, with the majority of cardiac-related reasons occurring after the 3rd day post-discharge. Based on BRIDGE readmission rates, follow-up at 14 days substantially reduces 30-day readmissions in both ACS and CHF patients. However, seeing patients earlier or additionally during the 4-7 day period may further reduce 30-day readmissions.

Heart failure is a long-term health condition that is characterized by multiple re-admissions throughout the patient's life. The economic burden and the impairment of quality of life are too prominent in patients with heart failure. The aim of the study was to determine re-admission rate and predictors of re-admission in patients with heart failure at Ayub Teaching hospital Abbottabad. A data of 350 patients with heart failure who were admitted & readmitted to the coronary care unit with heart failure were included in this study. Data was collected to determine the common factors that may dictate their readmission to hospital. Over all re-admission rate was 58.28 %(n=204) for the patients in our study cohort. Regarding readmission rates within a 90-days period, 41.7% (n=146) of the sample had no readmission events, 35.1% (n=123) had one readmission, and 23.1% (n=81) experienced two or more readmissions. In terms of comorbid conditions, 36.9% (n=129) of the patients had a diagnosis of diabetes mellitus, while 57.7% (n=202) had hypertension. There was a statistically significant association between readmission within 90 days following first hospitalization for heart failure and diabetes mellitus, Increased Heart Rate, Nephropathy and an increased Neutrophil: Lymphocyte ratio (p<0.05). Diabetes mellitus, elevated heart rate, the presence of nephropathy, and an increased neutrophil-lymphocyte ratio were found to be independent predictors of subsequent heart failure readmission. These risk factors could potentially serve as simple indicators for forecasting the likelihood of heart failure readmission following patient discharge.

Improving Heart Failure Patient Transitions of Care and Reducing Readmissions with a Structured Hand-off Process