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CMS Readmission Risk Score Predicts Poor Outcomes at Hospitalization
S70 Journal of Cardiac Failure Vol. 21 No. 8S August 2015 eliminated delays in the titration process. The original order set is found easily within the EMR and may be referenced by all care providers.
151 Inferior Vena Cava Dilatation Predicts Mortality and Worsening Renal Function in Patients With Chronic Heart Failure Abdul Hafidz Muhammad Iqbal, Bayan Soujeri, Hawkey Sean, Daniel Levin, Muhammad Zaid Iskandar, Graham Stewart, Joanne Sloan, Chim Lang; University of Dundee, Dundee, United Kingdom Introduction: Although heart failure is thought to cause worsening renal function (WRF) through hypo perfusion secondary to a reduction in cardiac output, there is evidence to suggest that renal venous congestion may also be a contributing factor. Invasive studies have shown that central venous pressure predicts WRF in heart failure patients with a preserved cardiac output; however, non-invasive studies investigating this relationship are scarce. Potentially, assessment of inferior vena cava (IVC) diameter can be used to estimate venous congestion, as raised right arterial pressures dilate the IVC making it non-collapsible. We therefore aimed to investigate the association between IVC diameter and outcomes, including WRF, heart failure hospitalisations and all-cause mortality. Methods: We conducted a retrospective cohort study of 1,078 chronic heart failure (CHF) patients from the BIOSTAT-CHF Scotland study. All CHF patients were symptomatic, requiring the use of loop diuretics, and were optimally treated on recommended therapy for CHF. Venous congestion (VC) was defined as IVC diameter O2.1cm, identified from echocardiography at baseline review. Renal function was determined by estimated glomerular filtration rate (eGFR) using the abbreviated MDRD equation. Logistic regression models were used to examine the association between VC and eGFR. Cox proportional hazard models were applied to examine the influence of VC on all-cause mortality and CHF hospitalisations. Results: Multivariate analysis showed that those with VC had significantly worse survival than those without VC after adjusting for age, sex, eGFR and furosemide daily dose (hazard ratio [HR]: 1.6, 95% CI: 1.22.1; p50.01). Although time to first CHF hospitalisation was shorter for the VC group compared to those without VC, this was not a statistically significant difference. Logistic regression models showed that those with severe renal impairment (eGFR60 (Odds Ratio57.7 (1.6-37.5), p50.012)). Conclusions: IVC width as an indirect measurement of renal venous congestion predicts worse survival in CHF and is associated with severe renal impairment. As an easily obtainable non-invasive predictor of renal venous congestion, IVC diameter could therefore be a potentially useful marker for both renal function and overall prognosis in CHF patients.
HF and Cardiology services. Given the lack of generalizable patient-centered risk scores designed for inpatient implementation, further investigation of the prognostic utility of the CMS Readmission Score seems appropriate.
153 Heart to Heart: An Innovative Hospice Program for Heart Failure Patients Abigail Newton, Martha Hager, Ronetta Marhoover, Patricia Pletke, Stephen Rennyson; Centra Health, Lynchburg, VA Background: Congestive Heart Failure (CHF) is a chronic progressive cardiac disorder. It is the primary reason for readmissions in the United States. In an effort to assist advanced CHF patients we collaborated with hospice. Our goal was to improve the quality of life for end stage CHF patients. Many advanced CHF patients are eligible for hospice; however they do not access these services due to perceived barriers: fear they will lose contact with their cardiology team, misperceptions of hospice services, or fear that symptoms will be inadequately managed. Methods: The CHF and hospice teams began meeting on a monthly basis to develop innovative ideas to improve the outpatient management for CHF patients. The main objectives included: identification of patients who met hospice criteria, increased utilization of hospice services, education of patients and families, improved symptom management, and decreased unnecessary hospitalizations. A resource call list was developed to improve communication between hospice and CHF teams. Home emergency kits were developed with specific CHF medications. Protocols were also developed for in-home inotropic and intravenous diuretic therapy. Results: A total of 35 patients were shared by the CHF clinic and hospice during the study dates of 11/2013 and 11/2014. During this time, one patient was re-hospitalized for heart failure within a 30-day period. Four of the 35 patients revoked hospice services to pursue more aggressive treatment options. Four patients were managed with home inotropic support. Success of the program has led to the development of a joint palliative care pilot project for CHF patients who are not eligible for hospice services but needed additional in-home support. Conclusion: As CHF patients approach end of life, collaboration between heart failure providers and hospice provides patients with services needed to achieve maximum quality of life and reduce the number of hospital re-admissions for heart failure.
152 CMS Readmission Risk Score Predicts Poor Outcomes at Hospitalization Evelyn Dean1, Omima Ali2, Kevin F. Kennedy1, Anthony Magalski1, Bethany A. Austin1; 1Saint Luke’s Mid America Heart Institute, Kansas City, MO; 2University of Missouri-Kansas City, Kansas City, MO Introduction: Risk stratifying hospitalized heart failure (HHF) patients remains a challenge with few risk scores developed specifically for inpatient purposes that are broadly applicable. The CMS Readmission Risk Score was developed to facilitate estimation of hospital readmission rates for HHF patients based on Medicare claims data but has not been utilized for prognostic purposes. Objectives: To evaluate if HHF patients with high risk CMS Readmission scores are also at higher risk of poor outcomes including death. Methods: CMS risk score was calculated using the Readmission for Heart Failure calculator (developed and validated for CMS by Yale) on all admissions to the Advanced HF Service from 10/2013-9/2014. After initial data from the HF service was gathered, risk score was calculated on matched HF patients admitted to the Cardiology service. Each chart was reviewed 30 days post discharge for outcomes of all cause readmission, death in hospital, and discharge to hospice. Youden ROC point was used to calculate the most optimal cutpoint of risk. Groups were compared using chi-square and Student’s t tests Results: CMS risk scores were calculated on 150 serial admissions for patients HHF on the HF service and 92 matched HHF patients on the Cardiology service from 10/2013-9/2014. The mean age was 64.7616.0. Mean score overall was 26.365.3 and overall all cause 30 day readmission rate was 22.7%. A majority (55%) of the patients on the HF service had a score $ 27 vs 32% of the Cardiology patients. Those with scores $ 27 had 5.1 times greater chance of being discharged with hospice (11 vs. 2%, p 50.007) and 2.7 times greater chance of death during hospitalization or discharge to hospice (16 vs 7%, p 5 0.024) (Table 1). There was no significant difference in the risk score cut point associated with poor outcomes in the HF vs. Cardiology patients. Conclusions: CMS Readmission Risk Score $ 27 was a marker of poor outcome in a cohort of HHF patients with both preserved and decreased ejection fraction admitted to both
Figure 1.
Figure 2.
154 Table 1.
Age Risk Score Readmission in 30 Days Discharge: Hospice Death or Hospice
Risk!27%
Risk $27%
p-value
62.9 6 19.4 22.3 6 2.5 27 (20.8%) 3 (2.3%) 9 (6.9%)
66.2 6 10.5 31.0 6 3.2 28 (25.0%) 12 (10.7%) 18 (16.1%)
0.079 ! 0.001 0.435 0.007 0.024
Experience of a Newly Established Multidisciplinary Heart Failure Clinic at a VA Hospital Christina W. Rivers, Angela C. Ross, Nina Giustino, Lonnie Edwards, Siobhan Martin, Edward Hines, Jr; VA Hospital, Hines, IL Background: Heart failure (HF) readmissions is a financial burden to the patient, family and healthcare system. The cost of a hospital bed at the VA averages $2,000-$5,000 per day. In 2009, Hines VA Hospital established a team to evaluate Heart Failure readmissions. A review of a sample of this patient population revealed
151 Inferior Vena Cava Dilatation Predicts Mortality and Worsening Renal Function in Patients With Chronic Heart Failure Abdul Hafidz Muhammad Iqbal, Bayan Soujeri, Hawkey Sean, Daniel Levin, Muhammad Zaid Iskandar, Graham Stewart, Joanne Sloan, Chim Lang; University of Dundee, Dundee, United Kingdom Introduction: Although heart failure is thought to cause worsening renal function (WRF) through hypo perfusion secondary to a reduction in cardiac output, there is evidence to suggest that renal venous congestion may also be a contributing factor. Invasive studies have shown that central venous pressure predicts WRF in heart failure patients with a preserved cardiac output; however, non-invasive studies investigating this relationship are scarce. Potentially, assessment of inferior vena cava (IVC) diameter can be used to estimate venous congestion, as raised right arterial pressures dilate the IVC making it non-collapsible. We therefore aimed to investigate the association between IVC diameter and outcomes, including WRF, heart failure hospitalisations and all-cause mortality. Methods: We conducted a retrospective cohort study of 1,078 chronic heart failure (CHF) patients from the BIOSTAT-CHF Scotland study. All CHF patients were symptomatic, requiring the use of loop diuretics, and were optimally treated on recommended therapy for CHF. Venous congestion (VC) was defined as IVC diameter O2.1cm, identified from echocardiography at baseline review. Renal function was determined by estimated glomerular filtration rate (eGFR) using the abbreviated MDRD equation. Logistic regression models were used to examine the association between VC and eGFR. Cox proportional hazard models were applied to examine the influence of VC on all-cause mortality and CHF hospitalisations. Results: Multivariate analysis showed that those with VC had significantly worse survival than those without VC after adjusting for age, sex, eGFR and furosemide daily dose (hazard ratio [HR]: 1.6, 95% CI: 1.22.1; p50.01). Although time to first CHF hospitalisation was shorter for the VC group compared to those without VC, this was not a statistically significant difference. Logistic regression models showed that those with severe renal impairment (eGFR60 (Odds Ratio57.7 (1.6-37.5), p50.012)). Conclusions: IVC width as an indirect measurement of renal venous congestion predicts worse survival in CHF and is associated with severe renal impairment. As an easily obtainable non-invasive predictor of renal venous congestion, IVC diameter could therefore be a potentially useful marker for both renal function and overall prognosis in CHF patients.
HF and Cardiology services. Given the lack of generalizable patient-centered risk scores designed for inpatient implementation, further investigation of the prognostic utility of the CMS Readmission Score seems appropriate.
153 Heart to Heart: An Innovative Hospice Program for Heart Failure Patients Abigail Newton, Martha Hager, Ronetta Marhoover, Patricia Pletke, Stephen Rennyson; Centra Health, Lynchburg, VA Background: Congestive Heart Failure (CHF) is a chronic progressive cardiac disorder. It is the primary reason for readmissions in the United States. In an effort to assist advanced CHF patients we collaborated with hospice. Our goal was to improve the quality of life for end stage CHF patients. Many advanced CHF patients are eligible for hospice; however they do not access these services due to perceived barriers: fear they will lose contact with their cardiology team, misperceptions of hospice services, or fear that symptoms will be inadequately managed. Methods: The CHF and hospice teams began meeting on a monthly basis to develop innovative ideas to improve the outpatient management for CHF patients. The main objectives included: identification of patients who met hospice criteria, increased utilization of hospice services, education of patients and families, improved symptom management, and decreased unnecessary hospitalizations. A resource call list was developed to improve communication between hospice and CHF teams. Home emergency kits were developed with specific CHF medications. Protocols were also developed for in-home inotropic and intravenous diuretic therapy. Results: A total of 35 patients were shared by the CHF clinic and hospice during the study dates of 11/2013 and 11/2014. During this time, one patient was re-hospitalized for heart failure within a 30-day period. Four of the 35 patients revoked hospice services to pursue more aggressive treatment options. Four patients were managed with home inotropic support. Success of the program has led to the development of a joint palliative care pilot project for CHF patients who are not eligible for hospice services but needed additional in-home support. Conclusion: As CHF patients approach end of life, collaboration between heart failure providers and hospice provides patients with services needed to achieve maximum quality of life and reduce the number of hospital re-admissions for heart failure.
152 CMS Readmission Risk Score Predicts Poor Outcomes at Hospitalization Evelyn Dean1, Omima Ali2, Kevin F. Kennedy1, Anthony Magalski1, Bethany A. Austin1; 1Saint Luke’s Mid America Heart Institute, Kansas City, MO; 2University of Missouri-Kansas City, Kansas City, MO Introduction: Risk stratifying hospitalized heart failure (HHF) patients remains a challenge with few risk scores developed specifically for inpatient purposes that are broadly applicable. The CMS Readmission Risk Score was developed to facilitate estimation of hospital readmission rates for HHF patients based on Medicare claims data but has not been utilized for prognostic purposes. Objectives: To evaluate if HHF patients with high risk CMS Readmission scores are also at higher risk of poor outcomes including death. Methods: CMS risk score was calculated using the Readmission for Heart Failure calculator (developed and validated for CMS by Yale) on all admissions to the Advanced HF Service from 10/2013-9/2014. After initial data from the HF service was gathered, risk score was calculated on matched HF patients admitted to the Cardiology service. Each chart was reviewed 30 days post discharge for outcomes of all cause readmission, death in hospital, and discharge to hospice. Youden ROC point was used to calculate the most optimal cutpoint of risk. Groups were compared using chi-square and Student’s t tests Results: CMS risk scores were calculated on 150 serial admissions for patients HHF on the HF service and 92 matched HHF patients on the Cardiology service from 10/2013-9/2014. The mean age was 64.7616.0. Mean score overall was 26.365.3 and overall all cause 30 day readmission rate was 22.7%. A majority (55%) of the patients on the HF service had a score $ 27 vs 32% of the Cardiology patients. Those with scores $ 27 had 5.1 times greater chance of being discharged with hospice (11 vs. 2%, p 50.007) and 2.7 times greater chance of death during hospitalization or discharge to hospice (16 vs 7%, p 5 0.024) (Table 1). There was no significant difference in the risk score cut point associated with poor outcomes in the HF vs. Cardiology patients. Conclusions: CMS Readmission Risk Score $ 27 was a marker of poor outcome in a cohort of HHF patients with both preserved and decreased ejection fraction admitted to both
Figure 1.
Figure 2.
154 Table 1.
Age Risk Score Readmission in 30 Days Discharge: Hospice Death or Hospice
Risk!27%
Risk $27%
p-value
62.9 6 19.4 22.3 6 2.5 27 (20.8%) 3 (2.3%) 9 (6.9%)
66.2 6 10.5 31.0 6 3.2 28 (25.0%) 12 (10.7%) 18 (16.1%)
0.079 ! 0.001 0.435 0.007 0.024
Experience of a Newly Established Multidisciplinary Heart Failure Clinic at a VA Hospital Christina W. Rivers, Angela C. Ross, Nina Giustino, Lonnie Edwards, Siobhan Martin, Edward Hines, Jr; VA Hospital, Hines, IL Background: Heart failure (HF) readmissions is a financial burden to the patient, family and healthcare system. The cost of a hospital bed at the VA averages $2,000-$5,000 per day. In 2009, Hines VA Hospital established a team to evaluate Heart Failure readmissions. A review of a sample of this patient population revealed