Hospitals can slow the revolving door that shuttles heart failure patients back into bed within a month of going home by following up promptly to ensure patients get the right outpatient care, a study shows.
On average, nearly 20% of the 1 million heart failure patients admitted to U.S. hospitals each year are readmitted within a month. Heart failure is the leading cause of those readmissions, which overall cost Medicare $17 billion every year and amount to 20% of all Medicare payments, government data show.
The new study involved more than 30,000 Medicare patients, ages 65 and older, at 252 hospitals that supply data to an American Heart Association (AHA) quality-improvement program.
It found that more than half of the hospitals in the study failed to follow up with patients for a week after their discharge, though most are elderly, frail and taking a different mix of prescriptions or dosages.
"Early follow-up after discharge for heart failure is low across the board," says lead author Adrian Hernandez of Duke University.
Patients discharged from hospitals that check up promptly were almost 15% less likely to need rehospitalization so soon, researchers found. Going back into the hospital not only heaps more trauma on patients, it also drives up costs, says the study in today's Journal of the American Medical Association.
Heart failure readmissions vary dramatically from one hospital to another, a Medicare analysis of data from 2005 to 2008 shows. Baylor Heart and Vascular Hospital in Dallas led the nation with a low readmission rate of just under 16%, while Lincoln Medical and Mental Health Center in the Bronx came in last nationwide by readmitting 34% of its heart failure patients in 30 days.
Study co-author Gregg Fonarow of UCLA says the transition from hospital to home is a "vulnerable period" for heart failure patients, who must maintain strict, low-salt diets and manage multiple medications.
"If patients don't take care of themselves when they go home, they're right back in again," says Joseph Bove, a heart failure expert at Temple University in Philadelphia.
Yet key questions remain unanswered, including who is responsible for these patients' care. "Is it the hospital's responsibility? Is it the physician? Or Medicare? It's that handoff that counts," Fonarow says.
The AHA, the American College of Cardiology and other medical groups have targeted heart failure readmissions as an opportunity to significantly improve medical care. The American College of Cardiology has enrolled about 693 hospitals in its H2H -- "hospital to home"-- program to help hospitals establish better transitions for patients. "The secret to success post-discharge is communication," says Bove, a leader in that effort.
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