Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure
Related Experiment Videos
G C Fonarow1, L W Stevenson, J A Walden
1Ahmanson-University of California, Los Angeles Cardiomyopathy Center, USA.
Insights
A comprehensive heart failure management program significantly reduced hospital readmissions by 85% and improved patient functional status. This approach offers a potential to decrease symptoms and healthcare costs for advanced heart failure patients.
Area of Science:
- Cardiology
- Heart Failure Management
- Clinical Outcomes
Background:
- Advanced heart failure is characterized by progressive clinical deterioration and frequent hospital admissions, representing a significant financial burden.
- Frequent hospitalizations are a hallmark of advanced heart failure, leading to substantial healthcare costs.
Purpose of the Study:
- To evaluate the impact of a comprehensive heart failure management program on functional status and hospital readmission rates.
- To compare hospital readmission rates and estimated costs for the six months preceding and following referral to the program.
Main Methods:
- A 3-year study involving 214 patients with advanced heart failure (New York Heart Association functional class III or IV) awaiting heart transplantation.
- Interventions included medical therapy adjustments (e.g., increased ACE inhibitor dose, flexible diuretic regimen), intensive patient education, diet counseling, and progressive exercise.
- Key patient metrics included low left ventricular ejection fraction (0.21) and peak oxygen consumption (11 ml/kg per min), with an average of 2.0 hospital admissions per patient in the prior six months.
Main Results:
- Hospital readmissions decreased by 85% (0.29 per patient) in the six months post-referral compared to the pre-referral period (p < 0.0001).
- Functional status significantly improved, evidenced by enhanced functional class (p < 0.0001) and increased peak oxygen consumption (15.2 ml/kg per min, p < 0.001).
- Estimated cost savings of $9,800 per patient were observed, even after accounting for initial management costs.
Conclusions:
- Comprehensive heart failure management significantly improves functional status and drastically reduces hospital admission rates in transplant candidates.
- The program's success in mitigating symptoms and reducing costs suggests its value for managing persistent functional class III and IV heart failure, not solely for transplant selection.
- Referral to specialized heart failure programs can optimize patient outcomes and decrease healthcare expenditures.
Objectives:
To assess the impact of a comprehensive heart failure management program, functional status, hospital readmission rate and estimated hospital costs were determined and compared for the 6 months before and the 6 months after referral.
Background:
The course of advanced heart failure is characterized by progressive clinical deterioration reflected in frequent hospital admissions, which comprise the major financial cost.
Methods:
Over a 3-year period, 214 patients were accepted for heart transplantation and discharged after evaluation, which included adjustments in medical therapy and intensive patient education. Patients were in New York Heart Association functional class III or IV (94 and 120 patients, respectively), with a mean left ventricular ejection fraction of 0.21, peak oxygen consumption of 11 ml/kg per min and a total of 429 hospital admissions in the previous 6 months (average 2.0 per patient). Changes in the medical regimen included a 98% increase in angiotensin-converting enzyme inhibitor dose and a flexible diuretic regimen after 4.2-liter net diuresis, with counseling also regarding diet and progressive exercise.
Results:
During the 6 months after referral, there were only 63 hospital readmissions (85% reduction), with 0.29/patient (p < 0.0001). Functional status improved as assessed by functional class (p < 0.0001) and peak oxygen consumption (15.2 vs. 11.0 ml/kg per min, p < 0.001). The same results were seen after excluding the 35 patients without full 6-month follow-up (9 deaths, 14 urgent transplant procedures during hospital readmission, 12 elective transplant procedures from home); 34 hospital admissions occurred after referral, compared with 344 before referral. Even when adding in the initial hospital admission after referral for these 179 patients, there was a 35% decrease in total hospital admissions in the 6-month period. The estimated savings in hospital readmission costs after subtracting the initial hospital costs for management was $9,800 per patient.
Conclusions:
Comprehensive heart failure management led to improved functional status and an 85% decrease in the hospital admission rate for transplant candidates discharged after evaluation. The potential to reduce both symptoms and costs suggests that referral to a heart failure program may be appropriate not only for potential heart transplantation, but also for medical management of persistent functional class III and IV heart failure.