Background: Heart failure (HF) remains an epidemic with high morbidity, mortality and cost, which has been largely attributed to 30-day readmissions, with a national average of 23%. OBJECTIVE: To assess the impact on readmission rates of a heart failure clinic dedicated to taking care of advanced heart failure patients with limited resources and multiple readmissions.
Methods: A multidisciplinary heart failure team was established, including a lead physician, case managers, pharmacist, social service, dietary, nurse manager, nurse practitioners and HF RN. Guideline-directed medical therapy (GDMT) was enforced through standardized inpatient and outpatient order sets and algorithms, post-discharge one week follow-up appointments, and a structured transition of patient care from the inpatient to the outpatient setting. Free medications were secured when needed. The 30-day readmission rates were analyzed over a 3-year period since the inception of the program, using the Chi-square test.
Results: The total 30-day readmission rate prior to implementation of the heart failure team was 12.4%, with 4.9% readmitted with heart failure as a primary cause (primary), and 7.5% readmitted with heart failure as a secondary cause (secondary). In the following year, the total readmission rate was 10.5% (4.9% primary and 5.6% secondary). Two years later, the total readmission rate fell drastically to 5.7% (1.8% primary and 3.9% secondary, P < 0.05). Increased compliance with clinic visit appointments and adherence to GDMT recommendations were documented, in addition to demonstration of overall institutional cost-saving.
Discussion: Congestive heart failure is an extremely morbid and costly epidemic associated with high mortality. The 30-day readmission rates add tremendously to the cost of caring for heart failure patients, in addition to further worsening the overall morbidity and mortality. We report the experience of a small university-based program in addressing this problem utilizing a multidisciplinary team, in addition to external resources, to enforce GDMT, and improve patient participation and compliance with treatment recommendations. The total readmission rates significantly declined, with the biggest impact observed when heart failure was the primary diagnosis. The heart failure team was awarded the American Heart Association Get With The Guidelines (GWTG) Heart Failure Gold Plus Quality Achievement Award, in recognition of the significant positive impact the team had on the overall care of heart failure patients. Our model should be applicable to other practices, with little additional resources and with increased coordination, yielding tremendous clinical improvements and overall net financial savings.