Heart Failure
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Heart Failure
About 5.7 million persons in the United States have heart failure (HF). HF accounts for about 26.9% of 30-day readmission, making it the highest cause of hospital readmissions among surgical and medical conditions (Nair et al., 2020). Multiple factors contribute to the high readmission rates among patients with HF. First, HF is a chronic and progressive disease needing daily management to prevent readmission, unlike other cardiac conditions such as acute myocardial infarction. As a result, HF is typified by a series of decompensation, after which persons do not regain their initial quality of life and need higher care intensity (Gupta & Fonarow, 2018). This natural history occurs in a downward spiral until the pump fails and the individual dies. Second, heart failure with reduced ejection fraction impairs the perfusion of several organs, leading to multiorgan failure or dysfunction. Third, most patients with HF have several comorbid conditions because they tend to be older than 65 years (Goldgrab et al., 2019). Conditions that coexist with heart failure include hypertension, diabetes, anemia, dyslipidemia, chronic kidney disease, and cancers. Fourth, readmission rates are higher among HF patients because of a higher prevalence of depression in this group. Up to about 28% of patients with HF have comorbid depression (Health Quality Ontario, 2017). Depression promotes low-grade inflammation, activates the sympathetic nervous system and the hypothalamus- anterior pituitary-adrenal cortical axis, creating a vicious cycle that worsens HF and establishes a vicious cycle. In addition, depression diminishes persons with HF self-care ability, promoting poor compliance with recommended treatment. Finally, symptoms of HF such as exertional dyspnea limits individuals' ability to comply with treatment recommendations such as exercise. These factors interact to cause acute decompensated heart failure, which accounts for the higher readmission rates in this population (Nair et al., 2020).
A multifactorial approach should be used to reduce readmission rates among patients with HF. First, patient education effectively reduces readmission rates among patients with HF. Patient education should focus on lifestyle modifications, medication compliance, and the significance of follow-up (Goldgrab et al., 2019). Providers should also be educated on appropriate care for patients with HF. Second, effective medical therapy effectively reduces readmission rates among patients with HF. Pharmacological agents that reduce HF readmission rates include angiotensin receptor blockers, angiotensin-receptor neprilysin inhibitors, and ivabradine (Goldgrab et al., 2019). These agents reduce readmissions by about 30% compared to angiotensin receptor inhibitors. The effect of these agents can be further enhanced by promoting adherence by patients with HF. Adherence can be promoted through interventions such as medication reconciliation and prefilled medical boxes. Third, comorbid medical and mental conditions should be adequately managed to reduce hospital readmissions associated with heart failure (Gupta & Fonarow, 2018). Fourth, remote hemodynamic monitoring also reduces readmission rates among patients with HF. Fifth, effective post-admission follow-up and transition of care (Health Quality Ontario, 2017). Patients should be followed up ideally within seven days after discharge. An interdisciplinary approach should be used to care for patients with HF. This team should consist of cardiologists, nurses, counselors, pharmacists, nutrition, exercise physiologists, physiotherapists, and social workers. Finally, evidence-based cardiac rehabilitation can reduce readmission among patients with HF (Gupta & Fonarow, 2018).
References
Goldgrab, D., Balakumaran, K., Kim, M. J., & Tabtabai, S. R. (2019). Updates in heart failure 30-day readmission prevention. Heart Failure Reviews, 24(2), 177–187. https://doi.org/10.1007/s10741-018-9754-4
Gupta, A., & Fonarow, G. C. (2018). The Hospital Readmissions Reduction Program-learning from the failure of a healthcare policy. European Journal of Heart Failure, 20(8), 1169–1174. https://doi.org/10.1002/ejhf.1212
Health Quality Ontario. (2017). Effect of early follow-up after hospital discharge on outcomes in patients with heart failure or chronic obstructive pulmonary disease: A systematic review. Ontario Health Technology Assessment Series, 17(8), 1–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466361/
Nair, R., Lak, H., Hasan, S., Gunasekaran, D., Babar, A., & Gopalakrishna, K. V. (2020). Reducing all-cause 30-day hospital readmissions for patients presenting with acute heart failure exacerbations: A quality improvement initiative. Cureus, 12(3), e7420. https://doi.org/10.7759/cureus.7420