Updates in heart failure 30-day readmission prevention

Goldgrab, David; Balakumaran, Kathir; Kim, Min Jung; Tabtabai, Sara

doi:10.1007/s10741-018-9754-4

Cited by 49 publications

(27 citation statements)

References 75 publications

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“…Telemonitoring with electronic communication between the patient and the team is also an opportunity that has been and will be evaluated. Several telemonitoring programs have been evaluated in diagnoses as heart failure, however the results in randomized controlled trials have been conflicting [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

et al. 2021

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Background The mortality of older patients after early discharge from hospitals is sparsely described. Information on factors associated with mortality can help identify high-risk patients who may benefit from preventive interventions. The aim of this study was to examine whether demographic factors, comorbidity and admission diagnoses are predictors of 30-day mortality among acutely admitted older patients discharged within 24 h after admission. Methods All medical patients aged ≥65 years admitted acutely to Danish hospitals between 1 January 2013 and 30 June 2014 surviving a hospital stay of ≤24 h were included. Demographic factors, comorbidity, discharge diagnoses and mortality within 30 days were described using data from the Danish National Patient Registry and the Civil Registration System. Cox regression was used to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for all-cause mortality. Results A total of 93,295 patients (49.4% men) with a median age of 75 years (interquartile range: 69–82 years), were included. Out of these, 2775 patients (3.0%; 95% CI 2.9–3.1%) died within 30 days after discharge. The 30-day mortality was increased in patients with age 76–85 years (aHR 1.59; 1.45–1.75) and 86+ years (aHR 3.35; 3.04–3.70), male gender (aHR 1.22; 1.11–1.33), a Charlson Comorbidity Index of 1–2 (aHR 2.15; 1.92–2.40) and 3+ (aHR 4.07; 3.65–4.54), and unmarried status (aHR 1.17; 1.08–1.27). Discharge diagnoses associated with 30-day mortality were heart failure (aHR 1.52; 1.17–1.95), respiratory failure (aHR 3.18; 2.46–4.11), dehydration (aHR 2.87; 2.51–3.29), constipation (aHR 1.31; 1.02–1.67), anemia (aHR 1.45; 1.27–1.66), pneumonia (aHR 2.24; 1.94–2.59), urinary tract infection (aHR 1.33; 1.14–1.55), dyspnea (aHR 1.57; 1.32–1.87) and suspicion of malignancy (aHR 2.06; 1.64–2.59). Conclusions Three percent had died within 30 days. High age, male gender, the comorbidity burden, unmarried status and several primary discharge diagnoses were identified as independent prognostic factors of 30-day all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

et al. 2021

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“…So was the percentage of studies that included patients who were hospitalized due to HF (e.g., unstable HF patients) lower in studies who did not report a beneficial effect of structured telephone support or non-invasive remote monitoring on the all-cause mortality, all-cause hospitalization, or HF-related hospitalization rates. Hospitalization for HF is associated with an increased risk for mortality as well as rehospitalizations [ 5 , 74 ]. In these unstable HF patients, non-invasive remote monitoring has the largest potential to improve their clinical outcomes and reduce the HF-related hospitalization rates.…”

Section: Reasons For Inconsistent Resultsmentioning

confidence: 99%

Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go?

Veenis

Radhoe

Hooijmans

et al. 2021

Sensors

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Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.

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“…The reduction of readmissions of patients with HF represents a challenge because several factors such as a lack of a targeted therapy for patients with preserved ejection fraction, the natural history of HF, the need for daily management to avoid decompensations and problems related to access to care, health literacy and other socioeconomic factors. 19 HF is a complex syndrome and the result of congestion and/or poor perfusion, leading to negative effects on multiple organ systems. In fact, patients with HF have multiple comorbidities, a heavy medication burden and experience symptoms that may be attributed to several aetiologies.…”

Section: Discussionmentioning

confidence: 99%

Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina

Roberti

Vita

Piastrella³

et al. 2020

BMJ Open

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ObjectivesThe aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).SettingHospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.ParticipantsTwenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.MethodsThis study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring.ResultsTwenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause.ConclusionFollowing a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.

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Updates in heart failure 30-day readmission prevention

Cited by 49 publications

References 75 publications

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go?

Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina

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