Preventing Heart Failure Remission

Written by:  Kirsten Cooper Pharm D Candidate Findlay University
Congestive heart failure (CHF) affects an estimated 6.5 million Americans and is responsible for more than 1 million hospital admissions each year.  CHF is the number one cause of  hospital admission for patients over the age of 65.  A 2012 article also cited that >50% of patients are readmitted within 6 months following a heart failure related admission.  Those numbers, coupled with concerns about CMS payment for readmission, make preventing heart failure readmissions a goal for all health care providers.
A facility's ability to prevent heart failure readmission effectively is likely to play into hospital referral choices for after stay care.  If a facility can better manage care, they are more likely to get additional referrals as the hospital knows they are less likely to see the patient readmitted.  
Long term care professionals can play a vital role in preventing readmission through some simple steps. Having plans in place for all CHF patients, long term and skilled care patients can improve care and prevent further readmissions.  Examples include:
  • Monitoring patient weight daily, particularly after transitions in care.
  • Having guidelines in place to contact attending physicians if weight gain is greater than 3 pounds per day or 5 pounds per week.
  • Updating dietary orders to reflect patient needs,  i.e. 2 gram sodium restricted diet. 
  • Assuring appropriate diuretics are ordered and reconciled.  Including routine medications and as needed medications for weight gain.
  • Optimize beta-blockers, as tolerated, keeping  the patient’s  blood pressure and pulse in mind when dosing.
  • Consider and attempt to address each confounding variable that can effect individual patient outcomes, such as psychosocial or socioeconomic factors
  • Assuring follow-up visits were made after admission, typically for patient to be seen within 3 to 5 days following hospital discharge. 
  • Set patients up for appropriate transitions to home, if part of the care plan.
Consider use of the American College of Cardiology’s one page checklist to better educate patients and families on what is required to best manage their condition.  Use of the checklist at hospital discharge was credited with lowering 30 day and 6 month readmission rates in the study.  This tool could also be utilized as part of short term skilled patient discharge instructions. 
While heart failure rates are unlikely to decrease drastically, the way it is managed is something that each facility and provider can have a hand in improving.  Consider a team at your facility to thoroughly evaluate how CHF patient care is managed and identify areas for improvement.  Significant reductions in readmission are possible.

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