Abstract P315: The Impact Of Neighborhood Factors On Hospital Readmission Among Depressed Patients With Systolic Heart Failure.

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Emily Guhl ◽  
Julia P Holber ◽  
Kwonho Jeong ◽  
Kaleab Z Abebe ◽  
Amy Anderson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Systolic Heart Failure ◽  
Activity Level ◽  
Readmission Rates ◽  
Neighborhood Factors ◽  
Depressed Patients ◽  
Walk Score ◽  
The Impact

Introduction: Neighborhood factors such as walkability and proximity to stores, parks, and public transportation have been associated with obesity, diabetes, and physical activity level as well as hospital readmission rates. Among individuals with systolic heart failure (HF), reducing hospital readmissions is challenging, but little is known on the role of neighborhood factors on hospital readmissions in this population. Hypothesis: We hypothesized that better walk scores and less deprivation would be associated with a lower readmissions in HF patients. Methods: We screened hospitalized patients with systolic HF (EF≤45%) and NYHA class II-IV symptoms for depression at 8 Pittsburgh-area hospitals as part of the Hopeful Heart Study (R01 HL114016) and included patients who screened positive for depression and remained depressed when re-contacted by telephone 2 weeks after discharge. We classified neighborhoods using the validated neighborhood Walk Score®and Area Deprivation Index for each patient’s address at study entry (both 0-100 scales), and assessed readmissions for 12 months following each patient’s enrollment. We then compared the ADI and Walk Score of individuals who were readmitted vs. those who were not. Results: Final analysis included 629 depressed patients with systolic HF (43% female, 75% white, 86% HTN, 52% DM). Overall, 73.1% of individuals were readmitted at least once, and readmitted and not readmitted patients had similar walk scores (34.1±25.2 vs. 32.2±27.0, p = 0.40) and ADI (66.6±23.1 vs. 64.2±22.7, p=0.50) as those who were not readmitted. Table 1. Conclusions: Among depressed patients with systolic HF, Walk Score and ADI were associated with not associated with readmission rates. Further research is warranted to determine how neighborhood factors adversely impact individual with co-morbid depression and systolic HF. Further analyses are ongoing to determine if individual components of the Walk Score and ADI contribute to differences in readmission.

Abstract P549: The Impact Of Neighborhood Factors On Mortality Among Depressed Patients With Systolic Heart Failure.

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Emily Guhl ◽  
Julia P Holber ◽  
Kwonho Jeong ◽  
Kaleab Z Abebe ◽  
Amy Anderson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Mortality Data ◽  
Area Deprivation ◽  
Neighborhood Factors ◽  
Depressed Patients ◽  
Significant Difference ◽  
Walk Score ◽  
The Impact

Introduction: Neighborhood factors have been associated with risk factors for cardiovascular disease.. Among These neighborhood factors also impact physical functioning and access to resources. In individuals with heart failure (HF), who require a significant access to care and physical activity, these neighborhood factors may impact mortality. Data are limited evaluating the association of neighborhood and mortality in HF. Hypothesis: We hypothesized that better walk scores and less deprivation would be associated with a lower mortality in individuals with systolic HF. Methods: We screened hospitalized patients with systolic HF (EF≤45%) and NYHA class II-IV symptoms for depression at 8 Pittsburgh-area hospitals as part of the Hopeful Heart Study (R01 HL114016) and included patients who screened positive for depression and remained depressed when re-contacted by telephone 2 weeks after discharge. We classified neighborhoods using the validated Walk Score®and Area Deprivation Index for each patient’s address at study entry (both 0-100 scales), and assessed all-cause and cardiovascular mortality over a 12 month period post-enrollment. Mortality (top quartile vs. all others) was compared between ADI and Walk Score groups with adjustment for clinical covariates using Kaplan Meier survival analysis. Results: Final analysis included 629 depressed patients with systolic HF (43 % female, 75 % white, 86% HTN, 52% DM). There was no significant difference In mortality when comparing individuals in the top quartile of Walk Score (p = 0.381) or ADI (p = 0.379) to all others (Figure 1). Conclusions: Among depressed patients with systolic HF, there was no significant association between neighborhood factors including Walk Score or ADI and mortality. Further research is warranted to determine how neighborhood factors adversely impact individual with co-morbid depression and systolic HF. Further analyses are ongoing to determine if individual components of the Walk Score and ADI contribute to differences in mortality.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions?

2017 ◽  
Vol 31 (1) ◽  
pp. 40-45
Author(s):  
Ryan E. Owens ◽  
Jennifer D. Twilla ◽  
Timothy H. Self ◽  
Abdulrahman I. Alshaya ◽  
Carlvin J. Metra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Hospital Readmissions ◽  
Maximum Tolerated Dose ◽  
Target Dose ◽  
Readmission Rates ◽  
Reduced Ejection Fraction ◽  
Β Blocker ◽  
The Impact

Background: Raised resting heart rate (HR), >70 beats per minute (bpm), has been shown to be a risk factor for adverse cardiovascular outcomes and hospital readmissions, specifically in patients with heart failure with reduced ejection fraction (HF rEF). Given their mortality benefit, β-blockers are recommended in HF rEF, with a goal to titrate to a maximum tolerated dose rather than a specific HR target. Objective: To determine the impact of optimal HR control achievement prior to hospital discharge on hospital readmissions in patients with HF rEF receiving β-blockade. Methods: A retrospective study of patients admitted to 5 adult hospitals within a large urban health-care system, between 2013 and 2015, was conducted. Patients were identified via International Classification of Diseases, Ninth Revision ( ICD-9) coding for acute on chronic HF rEF. Results: Of the 225 patients included, 20% achieved optimal HR control (n = 46, HR <70 bpm; n = 179, HR ≥70 bpm) and only 15% received β-blocker titration during hospital admission. Of note, 25% of patients receiving ≥50% target dose (n = 79) and 28% receiving 100% target dose (n = 39) achieved optimal HR control. At 30 days, patients with an HR <70 bpm versus HR ≥70 bpm exhibited similar readmission rates (9% vs 11%, respectively; P > .99) and ED visits (11% vs 8%, respectively; P = .57). Conclusions: Readmission rates were similar among patients with HF rEF despite the majority failing to achieve optimal HR control from β-blockade. However, β-blocker dosing remains suboptimal relative to guideline-recommended target doses. Opportunities exist for inpatient clinicians to optimize β-blockade in an attempt to achieve HR control.

scholarly journals A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: A Retrospective Analysis (Preprint)

2021 ◽  
Author(s):  
Daniel Max Friedman ◽  
Jana Marie Goldberg ◽  
Rebecca Lynn Molinsky ◽  
Mark Andrew Hanson ◽  
Adam Castaño ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Care Program ◽  
Day Hospital ◽  
Skilled Nursing ◽  
Care Plans ◽  
The Impact ◽  
Cardiovascular Care

BACKGROUND Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, post-consultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc. (HBH), a cardiovascular digital health company, to 11 SNFs (3,510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. OBJECTIVE The aim of the study is to assess whether a virtual cardiovascular care program could improve access to specialty care, thereby reducing the 30-day hospital readmission rate for HF patients discharged to SNF relative to the expected rate for this population. METHODS We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted ≥1 telemedicine visit via smartphone, tablet, or laptop device for cardiac patients identified by a SNF care team. Post-consult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. RESULTS We observed lower hospital readmission among patients who received ≥1 virtual consultation compared to the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3,510 SNF beds. 185 patients (7%) received virtual cardiovascular care via the HBH program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as $860 per patient. CONCLUSIONS The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally-enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

Abstract 18599: Clinical Assessment of Hemodynamic Profiles Predict Readmission and Mortality in Diastolic Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Salpy V Pamboukian ◽  
Jose A Tallaj ◽  
Michael Falola ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Clinical Assessment ◽  
Diastolic Heart Failure ◽  
Clinical Care ◽  
Systolic Heart Failure ◽  
Health Care Expenditures ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Increased Risk

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

scholarly journals Impact of Pharmacy Student–Driven Postdischarge Telephone Calls on Heart Failure Hospital Readmission Rates: A Pilot Program

2018 ◽  
Vol 54 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Roda Plakogiannis ◽  
Ana Mola ◽  
Shreya Sinha ◽  
Abraham Stefanidis ◽  
Hannah Oh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Hospital Readmission ◽  
Pharmacy Students ◽  
Pharmacy Student ◽  
Pilot Program ◽  
Readmission Rates ◽  
Phone Calls ◽  
Hospital Readmission Rates ◽  
Telephone Calls

Background: Heart failure (HF) hospitalization rates have remained high in the past 10 years. Numerous studies have shown significant improvement in HF readmission rates when pharmacists or pharmacy residents conduct postdischarge telephone calls. Objective: The purpose of this retrospective review of a pilot program was to evaluate the impact of pharmacy student–driven postdischarge phone calls on 30- and 90-day hospital readmission rates in patients recently discharged with HF. Methods: A retrospective manual chart review was conducted for all patients who received a telephone call from the pharmacy students. The primary endpoint compared historical readmissions, 30 and 90 days prior to hospital discharge, with 30 and 90 days post discharge readmissions. For the secondary endpoints, historical and postdischarge 30-day and 90-day readmission rates were compared for patients with a primary diagnosis of HF and for patients with a secondary diagnosis of HF. Descriptive statistics were calculated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Results: Statistically significant decrease was observed for both the 30-day ( P = .006) and 90-day ( P = .007) readmission periods. Prior to the pharmacy students’ phone calls, the overall group of 131 patients had historical readmission rates of 24.43% within 30 days and 38.17% within 90 days after hospital discharge. After the postdischarge phone calls, the readmission rates decreased to 11.45%, for 30 days, and 22.90%, for 90 days. Conclusion: Postdischarge phone calls, specifically made by pharmacy students, demonstrated a positive impact on reducing HF-associated hospital readmissions, adding to the growing body of evidence of different methods of pharmacy interventions and highlighting the clinical impact pharmacy students may have in transition of care services.

HOSPITAL Score, LACE Index and LACE+ Index as predictors of 30-day readmission in patients with heart failure

2019 ◽  
Vol 25 (5) ◽  
pp. 166-167 ◽  
Author(s):  
Abdisamad M Ibrahim ◽  
Cameron Koester ◽  
Mohammad Al-Akchar ◽  
Nitin Tandan ◽  
Manjari Regmi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Patient Population ◽  
Prediction Models ◽  
Hospital Admissions ◽  
Diastolic Heart Failure ◽  
Hospital Readmissions ◽  
Medical Patients ◽  
Readmission Rates ◽  
C Statistic

This study aimed to evaluate the accuracy of the HOSPITAL Score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalization, Index admission, number of hospital admissions, Length of stay) LACE index (Length of stay, Acute/emergent admission, Charlson comorbidy index score, Emerency department visits in previous 6 months) and LACE+ index in predicting 30-day readmission in patients with diastolic dysfunction. Heart failure remains one of the most common hospital readmissions in adults, leading to significant morbidity and mortality. Different models have been used to predict 30-day hospital readmissions. All adult medical patients discharged from the SIU School of Medicine Hospitalist service from 12 June 2016 to 12 June 2018 with an International Classification of Disease, 10th Revision, Clinical Modification diagnosis of diastolic heart failure were studied retrospectively to evaluate the performance of the HOSPITAL Score, LACE index and LACE+ index readmission risk prediction tools in this patient population. Of the 730 patient discharges with a diagnosis of heart failure with preserved ejection fraction (HFpEF), 692 discharges met the inclusion criteria. Of these discharges, 189 (27%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation showed C-statistic values to be 0.595 (95% CI 0.549 to 0.641) for the HOSPITAL Score, 0.551 (95% CI 0.503 to 0.598) for the LACE index and 0.568 (95% CI 0.522 to 0.615) for the LACE+ index, indicating poor specificity in predicting 30-day readmission. The result of this study demonstrates that the HOSPITAL Score, LACE index and LACE+ index are not effective predictors of 30-day readmission for patients with HFpEF. Further analysis and development of new prediction models are needed to better estimate the 30-day readmission rates in this patient population.

THE IMPACT OF RENAL DYSFUNCTION IN OUTPATIENTS WITH SYSTOLIC HEART FAILURE

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 291S
Author(s):  
Jun R. Chiong ◽  
Binu Jacob ◽  
Robert F. Percy ◽  
Hector P. Sanchez ◽  
Anabel C. Castro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Systolic Heart Failure ◽  
The Impact

scholarly journals Patient engagement with digital disease management and readmission rates: The case of congestive heart failure

2021 ◽  
Vol 27 (3) ◽  
pp. 146045822110309
Author(s):  
Rudin Gjeka ◽  
Kirit Patel ◽  
Chandra Reddy ◽  
Nora Zetsche
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Disease Management ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
The Elderly ◽  
Readmission Rates ◽  
Management Platform ◽  
High Readmission Rate ◽  
Remote Patient

Congestive heart failure (CHF) is one of the most common diagnoses in the elderly United States Medicare (⩾ age 65) population. This patient population has a particularly high readmission rate, with one estimate of the 6-month readmission rate topping 40%. The rapid rise of mobile health (mHealth) presents a promising new pathway for reducing hospital readmissions of CHF, and, more generally, the management of chronic conditions. Using a randomized research design and a multivariate regression model, we evaluated the effectiveness of a hybrid mHealth model—the integration of remote patient monitoring with an applied health technology and digital disease management platform—on 45-day hospital readmissions for patients diagnosed with CHF. We find a 78% decrease in the likelihood of CHF hospital readmission for patients who were assigned to the digital disease management platform as compared to patients assigned to control.

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