Abstract 097: Effects of BRIDGE Attendance on the Outcomes of Diabetic Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Caitlin Fette ◽  
Rachel Krallman ◽  
Colin McMahon ◽  
Daniel Montgomery ◽  
Jennifer Wang ◽  
...  
Keyword(s):  
Transitional Care ◽  
Care Program ◽  
Primary Diagnosis ◽  
Lower Mortality ◽  
Diabetic Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Discharge Outcomes

Background: Prior studies have shown that patients with diabetes mellitus (DM) have increased risk for developing cardiovascular disease. BRIdging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner-delivered cardiac transitional care program for patients who have been recently discharged following a cardiac event. Previous research has shown BRIDGE to be effective in improving patient outcomes. This study sought to describe differences in outcomes 1) of heart failure (HF), acute coronary syndrome (ACS), and atrial fibrillation (AF) patients with and without concomitant DM, and 2) between diabetic patients who did and did not attend BRIDGE. Methods: Retrospective data were abstracted for HF, ACS, and AF patients from 2008-2014. Patients were divided into cohorts based on presence or absence of DM and BRIDGE attendance versus non-attendance. Outcomes (readmissions, ED visits, death) within each primary diagnosis (HF, ACS, AF) were compared between DM and non-DM patients and between those who attended BRIDGE versus those who did not for all DM patients. Results: Of 2197 patients referred to BRIDGE, 723 (32.9%) had concomitant DM. DM patients had similar outcomes to non-DM patients for most post-discharge outcomes; however, DM ACS patients had higher readmission (42.2% v 29.6%, p<0.001) and death (10.5% v. 4.5%, p=0.001) rates within 6 months, and DM AF patients had higher readmission rates within 6 months (52.1% v 37.9%, p=0.006). HF patients with DM who attended BRIDGE had lower mortality rates within 6 months of discharge than those who did not (10.3% vs. 22.1%, p=0.014). No other significant differences in outcomes were seen between BRIDGE attendees and non-attendees. Conclusions: Though not significant, patients with DM had worse post-discharge outcomes than those without DM for all primary diagnoses. In the subset of DM patients, the 30-day readmission rate for ACS patients who attended BRIDGE was half of those who did not attend. Conversely, 30-day readmission rates for HF patients were greater if they attended. This may in part explain the significantly lower mortality rate among BRIDGE attenders with HF, where patients who needed readmission were identified during their BRIDGE appointment. Due to the high prevalence of DM, efforts to tailor transitional care for this population are needed.

Abstract 339: Insights into Readmission Rates of Atrial Fibrillation Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Thomas Vasko ◽  
Rachel Sylvester ◽  
William Froehlich ◽  
Meghana Subramanian ◽  
Alison Wiles ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transitional Care ◽  
Care Program ◽  
Post Discharge ◽  
Readmission Rates ◽  
Bridge Program ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Care Models

Purpose and Background: Bridging the Discharge Gap Effectively (BRIDGE) is an NP-driven transitional care program for cardiovascular patients. It has demonstrated lower rates of readmission for patients with acute coronary syndrome who participated, but a similar benefit was not seen for atrial fibrillation (AF) patients. We sought to assess differences between AF patients who participated in the BRIDGE program and those who did not. Methods: Retrospective review of all patients referred to BRIDGE with a primary discharge diagnosis of AF was conducted (n=148). An equal number of BRIDGE attendees was randomly matched to non-attendees (n=36). Univariate techniques were used to compare groups. Results: Of 148 AF patients referred to BRIDGE, 84 (56.8%) attended BRIDGE, 36 (24.3%) saw cardiologists or PCPs for their first post-discharge follow-up, and 28 (18.9%) saw other providers or had unknown follow up. There was no significant difference in median time to follow up (12.5 days for attendees vs 9.0 days for non-attendees, p=0.503). Of the 72 patients reviewed, 17 (23.6%) were readmitted within 30 days (Table 1). Non-attendees were more likely (85.7% vs 40% p=0.134) to be readmitted with AF/related diagnoses as compared to attendees. More than half of 30-day readmissions for BRIDGE attendees were unrelated to AF (n=6, 60.0%). There was a trend toward greater incidence of comorbid CAD, HTN, CHF, or vascular disease among BRIDGE attendees, compared to non-attendees. Conclusion: Readmission patterns vary in AF patients; comorbid conditions play a role in early 30-day readmissions for AF patients despite adequate transitional care. NP-driven transitional care models, compared to traditional follow-up with a physician provider, may help identify additional issues related to comorbidities, leading to readmission. A larger sample is needed to better understand this dichotomy and to determine what measures can be taken to enhance the BRIDGE program for AF patients.

Abstract 256: Readmission Avoidability in Acute Coronary Syndrome Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Maria Souphis ◽  
Rachel Sylvester ◽  
Alison Wiles ◽  
Meghana Subramanian ◽  
William Froehlich ◽  
...  
Keyword(s):  
Transitional Care ◽  
Drug Effects ◽  
Care Program ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
History Of ◽  
Definition Of ◽  
Avoidable Readmission ◽  
Cancer Complications ◽  
Avoidable Readmissions

Background: Readmissions for ACS are common, costly, and potentially preventable. According to Medicare 13.4% of AMI admissions were followed by a rehospitalization within 15 days. A 2007 MedPAC report declared 76% of 30-day readmissions preventable. These rates are used as quality indicators despite lack of consensus on the definition of avoidable and unavoidable readmissions. We sought to define these terms and to analyze the effect of these definitions on 30-day outcomes. Methods: BRIDGE (Bridging the Discharge Gap Effectively) is an NP-led transitional care program for cardiac patients within 14 days of discharge. Retrospective data were abstracted on ACS patients readmitted before their appointments between 2008-2010. All readmissions were characterized as avoidable or unavoidable. Definitions were developed from the literature and in concert with senior cardiologists. Avoidable readmission was defined as being the result of a patient or provider issue that if managed may have prevented the admission. Unavoidable readmissions were defined as a patient in need of acute care. Avoidability status was further divided as related or unrelated to the index diagnosis. Results: Of 1188 BRIDGE referrals 304 (25.6%) experienced ACS events. In comparison to the total ACS population, patients readmitted before their BRIDGE clinic appointment (BC) (n=21, 6.9%) tended to be older, female, and were less likely to have a history of a cath or AMI (Table 1). In this study, 81% (n=17) of early readmissions were deemed unavoidable and most (n=14, 66.7%) were attributed to non-ACS issues or disease progression. These unavoidable readmissions included patients with cancer complications, chest pain, or other non-related diagnoses. Only 19% (n=4) of the readmissions were declared avoidable as a result of patient lack of adherence or provider issues such as adverse drug effects. Conclusion: The majority of early (before BC) readmissions following an index hospitalization for ACS patients referred to BRIDGE were unavoidable and unrelated to ACS. A clear discrepancy is seen between the 76% preventable readmissions in the MedPAC report and the 19% preventable readmissions in this study. Distinctions between unavoidable and avoidable readmissions should inform the utility of 30-day readmission rates as quality metrics.

Abstract 304: Characteristics of Acute Coronary Syndrome Patients Referred to the Bridge Transitional Care Clinic By Time to Readmission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
George Cholack ◽  
Joshua Garfein ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Daniel G Montgomery ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Transitional Care ◽  
Discharge Planning ◽  
Post Discharge ◽  
Care Clinic ◽  
Icu Admission ◽  
Coronary Syndrome ◽  
Female Sex ◽  
Increased Risk ◽  
Early Readmission

Introduction: Prompt follow-up post-discharge is recommended by many readmission reduction initiatives. Identifying predictors of early readmission may inform discharge planning. We compared characteristics of acute coronary syndrome (ACS) patients (pts) based on time to readmission to determine factors associated with early readmission. Methods: Pts referred to the BRIDGE transitional care clinic following index admission for ACS from 2008-2017 were eligible. Demographics and inpatient clinical characteristics were compared between pts readmitted early (0-7 days post-discharge) versus late (8-30 days post-discharge). Multivariable logistic regression models were created to identify independent predictors of early readmission. Results: Of 1220 ACS pts, 198 were readmitted within 30 days; 70 (35.4%) were readmitted early, and 10.0% of these were readmitted for ACS. Early readmissions were more likely to be female, have an ED visit prior to readmission, and have an index ICU admission. Female sex [OR: 2.26, 95% CI: 1.23, 4.16] and ICU admission [OR: 2.20, 95% CI: 1.14, 4.24] were both independent predictors of early readmission. Conclusion: Female sex and ICU admission during index were associated with roughly twice the odds of early readmission. Non-white pts were also more often readmitted early (p=0.05), suggesting potential care disparities in this population. Future studies to identify pts at increased risk of early readmission and efforts to reduce disparities are warranted.

Abstract 338: BRIDGE: A Post-Discharge Transitional Care Model in over 1600 Cardiac Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Rachel Sylvester ◽  
Minnie Bluhm ◽  
William Froehlich ◽  
Meghana Subramanian ◽  
Alison Wiles ◽  
...  
Keyword(s):  
Transitional Care ◽  
Care Program ◽  
Clinic Visit ◽  
Cardiac Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Care Clinic ◽  
Charlson Comorbidity Score ◽  
History Of

Background: Current legislation imposes financial penalties for high 30-day readmissions for AMI. BRIDGE is a NP-led, post-discharge transitional care program for cardiac patients, aimed at ensuring prompt follow up (f/u; in 14 days) and care coordination. Herein we report the effect of BRIDGE on readmissions in over 1600 cases. Methods: Retrospective data was abstracted for patients referred to BRIDGE including demographics, comorbidities, medications, days to f/u, and 6-month outcomes by diagnosis. Results: Of 1955 patients referred to the BRIDGE clinic, 271 (13.9%) were excluded for adverse events prior to their visit (ED visit n=60, readmission n=193, or death n=14) or missing data (n=4). 1210 (71.9%) of patients from the remaining sample (n=1684) attended BRIDGE. Diagnoses included: ACS (n=462, 27.6%); angina (n=207, 12.4%); CAD (n=196, 11.7%); AFib (n=247, 14.7%); CHF (n=316, 18.9%); or other (n=256, 15.2%). With the exception of mental health disorders (35.4% v. 29.1%, p=.012) there were no baseline differences (including the Charlson Comorbidity Score) between non-attendees and attendees (Table 1). ACS attendees, compared to non-attendees, had a trend toward lower 30, 60, and 90 day readmission rates (Table 2). This was not observed for other diagnoses. Conclusions: A NP based transitional care clinic visit early post-discharge appears to reduce early readmissions for patients with an ACS, but in this study did not impact other cardiac conditions. Also, patients with a history of substance abuse or depression are significantly less likely to attend BRIDGE appointments. To avoid a lapse in care, these patients may need prompt f/u with their PCP or cardiologist to help reduce early readmissions.

Abstract 16135: Hyponatremia is Related to Higher 30-Day Rehospitalization and 1-Year Mortality Rates in Patients Admitted With an Acute Coronary Syndrome: TRACE-CORE

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brendan C Merchant ◽  
David D McManus ◽  
Darleen Lessard ◽  
Joel M Gore ◽  
Robert J Goldberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Serum Sodium ◽  
Odds Ratio ◽  
Transitional Care ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Early Readmission

Introduction: Although hospital survival rates are improving among patients admitted with an acute coronary syndrome (ACS), early readmission is common and 1-year survival remains less than optimal. Improved risk stratification during an index ACS admission could direct greater surveillance or transitional care interventions for vulnerable patient populations prior to discharge from the hospital. While hyponatremia is associated with adverse outcomes after acute decompensated heart failure, less is known about whether hyponatremia relates to key post-discharge outcomes in patients discharged from the hospital after an ACS. Hypothesis: Hyponatremia is associated with early readmission and 1-year mortality in hospital survivors of an ACS. Methods: Using data from TRACE-CORE (Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education), a diverse cohort of 2,081 patients discharged after an ACS, we examined the associations of admission hyponatremia (serum sodium ≤ 134 mmol/L) with 30-day readmission and 1-year all-cause mortality. Results: Cohort mean age was 61 (SD 11.3) years, 34% were women and 19% non-white. Hyponatremia was present in 10.9% and patients with hyponatremia had more pre-existing hypertension (p=0.002) and diabetes mellitus (p=0.001). GRACE scores and maximum troponin values were significantly higher in hyponatremic patients (p= 0.001 and 0.05, respectively). There was no significant difference in prior heart failure or home diuretic use between the two groups. Overall 1-year mortality was 4.58% and 30-day all-cause readmission rate was 13.46%. For patients with hyponatremia on admission, unadjusted odds of 30-day readmission were 36% higher (Odds Ratio 1.36, 95% CI 1.00 to 1.85) and 1-year mortality odds were almost 3-fold higher (Odds Ratio 2.79, 95% CI 1.71 to 4.55). Conclusions: Hyponatremia was associated with higher early readmission and lower 1-year survival. Serum sodium levels may represent a cost-effective biomarker of adverse post-discharge outcomes. The potential incremental prognostic information of serum sodium when added to existing readmission and post-discharge mortality risk prediction instruments should be investigated.

scholarly journals Ischemic and bleeding risk stratification in diabetic patients after acute coronary syndrome based on insulin requirement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Cavallari ◽  
E Sagazio ◽  
E Antonucci ◽  
P Calabro' ◽  
F Gragnano ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Antiplatelet Therapy ◽  
Clinical Benefit ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Diabetes Status ◽  
Increased Risk ◽  
Net Clinical Benefit

Abstract Background Diabetes is a known risk factor for a first or recurrent cardiovascular event, however, its association with an increased risk of bleeding is controversial. To date, no study has explored the prognostic weight of insulin therapy in the setting of ACS. Purpose To investigate the differential role of insulin versus no insulin therapy on ischemic and bleeding risks in patients with diabetes and ACS. Methods START-ANTIPLATELET is a prospective, real-world multicenter registry including consecutive patients admitted for ACS. For the purpose of this analysis, patients were stratified according to diabetes status and insulin therapy. We compared 1-year rates of major adverse cardiovascular events, a composite of cardiovascular death, myocardial infarction and stroke, and of any bleeding, according to diabetes status (no diabetes, diabetes not on insulin therapy, diabetes on insulin therapy). In addition, we evaluated the net clinical benefit of dual antiplatelet therapy with the newer P2Y12 inhibitors (ticagrelor or prasugrel) vs dual antiplatelet therapy with clopidogrel according to diabetes status. Results In an overall population of 907 patients, 198 had diabetes, 10.6% of whom were on insulin. From non-diabetic patients to diabetic patients not on insulin and diabetic patients on insulin there was a stepwise decrease of MACE-free survival (log-rank p 0.039) with incidence of events at 1 year being 3.8%, 6.8% (adjusted p vs no diabetes 0.49) and 12.5% (adjusted p vs no diabetes 0.047), respectively (Figure, panel A). The rates of any bleeding were higher in patients on insulin (20.8% vs 8.8% in those without diabetes and 5.8% in diabetic patients not receiving insulin; log-rank p 0.028; Figure, panel B). Multivariable analysis demonstrated an almost 5-fold increase of any bleeding in diabetic patients with vs without insulin (OR 4.98, 95% CI 1.46–16.92; p=0.010). In the overall population, the incidence of the net composite endpoint including MACE or major bleeding with the use of ticagrelor/prasugrel on top of aspirin was significantly lower compared to use of clopidogrel (4.7% vs 8.4%; OR 0.54, 95% CI 0.30–0.94, p=0.031). This net clinical benefit in patients receiving a newer P2Y12 inhibitor was regardless of the diabetes status (p for interaction 0.48). Conclusions In this cohort of ACS patients, the presence of diabetes stratified by insulin therapy was associated with a graded increase in the 1-year rates of MACE. Conversely, insulin therapy significantly contributed to the overall increase of bleeding risk in diabetes. Funding Acknowledgement Type of funding source: None

Impact of anxiety on the post-discharge outcomes of patients discharged from the hospital after an acute coronary syndrome

2019 ◽  
Vol 278 ◽  
pp. 28-33 ◽  
Author(s):  
Hoang Tran ◽  
Nancy Byatt ◽  
Nathaniel Erskine ◽  
Darleen Lessard ◽  
Randolph S. Devereaux ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Discharge Outcomes

Abstract TP366: Significant Reduction in Readmission Using Transitions Nurse

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kiersten Espaillat ◽  
Paula Buckner
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Adult Patients ◽  
Care Coordinator ◽  
Readmission Rates ◽  
Before And After

In an effort to reduce early hospital readmissions, Vanderbilt University Medical Center (VUMC) implemented a transitional care coordinator (TCC) to provide careful coordinated follow up care for stroke patients after hospital discharge. The aim of this study is to compare all cause thirty- day readmission rates of adult patients with a primary diagnosis of stroke before and after the implementation of a stroke services TCC. All adult patients admitted to VUMC with a primary diagnosis of stroke; ischemic, hemorrhagic, and TIA; and readmitted within the first thirty days following hospital discharge between January-June of 2015, 2016, 2017, & 2018 were analyzed. Readmission data from 2015 & 2016, prior to the implementation of the TCC was compared to readmission data from 2017 & 2018, after the TCC was implemented. A total of 1911 charts were reviewed for the timeframe January-June of 2015-2018. In 2015 there were 369 stroke admissions and 120 (33%) were readmitted and in 2016 there were 474 stroke admissions and 112 (24%) readmissions, before the TCC role was implemented. In 2017 there were 540 stroke admissions and 62 (11%) were readmitted and in 2018 there were 528 stroke admissions and 74 (14%) readmissions, after the TCC role was implemented. Hospital readmissions were reduced significantly after implementing a TCC.

scholarly journals Treatment of Patients in the Vulnerable Phase (at Discharge or Early after Discharge)

2017 ◽  
Vol 10 ◽  
Author(s):  
Yuri M. Lopatin ◽  
Giuseppe MC Rosano
Keyword(s):  
Heart Failure ◽  
Cardiovascular System ◽  
Clinical Course ◽  
Post Discharge ◽  
Risk Of Death ◽  
Increased Risk ◽  
Discharge Outcomes ◽  
Socioeconomic Burden

The clinical course of heart failure includes a period in which the patient is at increased risk of death or rehospitalisation for HF. This period is termed the “vulnerable phase” and occurs during the peri-acute HF phase, due to microenvironmental changes in the cardiovascular system. Typically, the vulnerability phase starts from the onset of an acute HF event leading to admission, continues through a peri-discharge period and lasts up to 6 months after discharge.These poor post-discharge outcomes also represent a significant socioeconomic burden. This articles reviews treatments that are beneficial in this important phase.

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