Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions

Abstract

The management of acute heart failure is shifting toward treatment approaches outside of a traditional hospital setting. Many heart failure providers are now treating patients in less familiar health care settings, such as acute care clinics, emergency departments, and skilled nursing facilities. In this review we describe the current pressures driving change in the delivery of acute heart failure and summarize the evidence regarding treatments for acute heart failure outside of the inpatient setting. We also provide considerations for the design of future treatment strategies to be implemented in alternative care settings. (J Cardiac Fail 2015;21:667e673)

New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment

“…Patients with worsening heart failure are increasingly being managed in non‐hospitalized settings (e.g. emergency departments, specialized clinics, observation units, hospital‐at‐home services), which is among other reasons, motivated by an effort to contain healthcare costs . The draft EMA Guideline addressed this trend by proposing that events of worsening of heart failure without hospitalization may be used as an additional endpoint.…”

Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals

“…3,4 To reduce readmission rates, Centers for Medicare & Medicaid Services has implemented a few policy changes, such as public reporting of readmission rates and reducing Medicare reimbursements for higher than expected readmission rates. 5 These changes have motivated medical community to initiate quality improvement programs such as Get With The Guidelines (GWTG)-HF, Hospital to Home and Target: HF, and many hospitals are joining them to improve adherence with performance measures and reduce readmissions. [5][6][7] Among hospitals reporting data to Centers for Medicare & Medicaid Services, hospitals enrolled in GWTG-HF program showed greater adherence with performance measures.…”

“…5 These changes have motivated medical community to initiate quality improvement programs such as Get With The Guidelines (GWTG)-HF, Hospital to Home and Target: HF, and many hospitals are joining them to improve adherence with performance measures and reduce readmissions. [5][6][7] Among hospitals reporting data to Centers for Medicare & Medicaid Services, hospitals enrolled in GWTG-HF program showed greater adherence with performance measures. 8 Previous studies showed differences of adherence to guideline-recommended care, quality-of-care indicators, and clinical outcomes between teaching hospitals (TH) and nonteaching hospitals (NTH).…”

Telemonitoring and Contemporary Outpatient Management of Patients with Heart Failure: Is it Time?

“…Reported side effects, including hypokalemia and worsening renal failure were transient and rare (31). While approximately one third of the population may eventually require admission and intensifi ed HF management (32), 30-day readmission rates were shown to decrease by 10% (33) and patients spend 3 fewer days on average in the hospital per every 6 months, leading to an estimated annular saving of $12,000 (34). Overall these fi ndings suggest that outpatient IV diuretic administration to a selected group of HF patients is safe and improves quality of life while reducing health care expenses.…”