The general sentiment among people is that once you catch a disease, the hospital becomes your second home. While some chronic diseases coupled with complexities of other problems may require multiple hospital visits, the same cannot be generalised. One of the primary and most concerning health problems is declining heart conditions and what tops the list is Congestive Heart Failure. Irrespective of the underlying cause, heart failure (HF) generates an enormous clinical, societal and economic burden. Healthcare providers around the world are trying to improve and transform patient care and disease management to help reduce the per capita cost of health care and reduce the need for hospital readmission.
Congestive Heart Failure is a chronic progressive condition that affects the pumping power of heart muscles. While often referred to as heart failure, in simple words it is a condition where the heart doesn’t pump blood as well as it should, which leads to inability or failure of the heart to meet the needs of organs and tissues for oxygen and nutrients. Though the symptoms are very basic such as shortness of breath, fatigue, swollen legs and rapid heartbeat, the stages could vary from developing to advanced.
People living with heart failure often get warnings like these from their bodies. Many ignore the signs that their condition is about to flare up, sometimes for days, before seeing their doctor or heading to the hospital. The symptoms do not fade away, but they are the warning signs of a worsening heart condition which we need to understand and address. Rapidly worsening heart conditions can put a tremendous strain on the heart, lungs, kidneys, and other organs and lead to Congestive Heart Failure. This condition usually requires hospitalization and often intensive care.
Congestive heart failure is one of the most common causes of hospitalization for people, especially those older than 65. It is also one of the top reasons of heart failure readmissions, the highest 30-day rehospitalization rate among medical and surgical conditions, accounting for up to 26.9% of the total readmission rates. This also adds up to the costs of overall healthcare. The diagnosis of congestive heart failure is based on knowing the individual’s medical history, a careful physical examination, and selected laboratory tests. The treatments could range from essential lifestyle modifications, addressing potentially reversible factors, medications, heart transplant, and mechanical therapies.
Congestive heart failure is a common disease with high mortality and morbidity. When a patient suffers a heart condition, it impacts the individual’s full body and overall well-being. Better physiological understanding has led to significant advances in therapy in recent years. However, patients who have had an acute hospitalization with heart failure continue to show a high rate of symptomatic relapse, with up to 25% readmitted within three months.
One of the significant challenges in heart failure therapy is to avert these relapses to prevent hospital readmission. The medical and health care providers aim towards a multifaceted improvement of quality of lifestyle to ensure that there is no relapse in the condition. It is also crucial to understand which patient populations are at a higher risk of readmissions and go after them. Heart failure management is a team effort, and the patient is the key player on the team. We can improve the readmission rates for heart failure patients by engaging the care providers together in an organized manner. Doctors, hospital staff and nurses, dietitian, family members and the patient themselves need to come together to realize the purpose and achieve success.
Much research has gone behind devising strategies that would help manage enhanced post-discharge care and lead to reduced hospital readmissions. Here’s a look at some useful techniques that can be used to prevent costly readmissions for patients suffering from heart failure.
- Comprehensive discharge planning: It starts with carefully deriving that the patient’s condition is stable enough to make them worthy of a discharge, leading to helping them with discharge instructions and teach-back techniques.
- Provide one-to-one in patient education: Improving patient education at discharge – Simply providing sufficient information to patients and helping them understand post-care instructions and way forward. The key here is personalized communication.
- Schedule follow-up physician appointments post-discharge: A crucial part of post-care, follow-up appointments, needs to be scheduled on the basis of the patient’s condition. Offering patients documentation of the follow-up appointment and identifying and addressing any barriers to keeping those appointments can also help reduce readmission rates.
- Initiating automated patient communication: Since the first 30 days after discharge is the most vulnerable, connecting with patients during that period helps monitor health and address any issues proactively. Automated, digital patient communication systems make it easy for clinicians to communicate with patients the way they prefer, such as text messages, emails, and automated phone calls.
- Promote in-home follow up – Implementing robust home healthcare programs to provide heart failure patients with post-discharge care can also be a powerful tool for preventing hospital readmissions. These include visits by physician assistants, nurses, or home health aides to reinforce self-care instructions, provide education, perform physical exams, offer medication reconciliation, and provide other types of care.
- Improved integration between hospital and primary care providers – A hand-in-hand approach that includes a vigilant follow-up and regular monitoring for check-ups, medication, visits and therapies by all care providers would go a long way.
Depending on individual cases’ requirements, combinations of these strategies can be created to provide post-discharge support to best suit the need of the hour, before the patients run into serious problems that result in readmission. In the end, a self-care approach is the key to managing heart health. It is up to the patient to take medications, make dietary changes, adhere to the therapy, keep the follow-up appointments, and adopt a healthy lifestyle to prevent any relapse. Effective and efficient communication between care providers and patients is needed to avoid hospital readmission after congestive heart failure.
- Nair R, Lak H, Hasan S, Gunasekaran D, Babar A, Gopalakrishna KV. Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative. Cureus. 2020;12(3):e7420. Published 2020 Mar 25. doi:10.7759/cureus.7420
- Mudge A, Denaro C, Scott I, Bennett C, Hickey A, A. Jones M, Heart Failure Program Readmissions. J. Hosp. Med 2010;3;148-153. doi:10.1002/jhm.563