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Health Related Quality of Life a Predictor of 30 Day Hospital Readmission among Heart Failure Patients
The 23rd Annual Scientific Meeting HFSA 351 Health Related Quality of Life a Predictor of 30 Day Hospital Readmission among Heart Failure Patients Lydia H. Albuquerque; William Paterson University, Wayne, NJ Background: Heart failure (HF) is the leading cause of hospital readmission among patients, age 65 years and older with the prevalence increasing 46% from 2012 to 2030, resulting in more than 8 million Americans affected. As defined by Healthy People 2020, health related quality of life measures, the way in which HF diagnosis could affect the physical, emotional, mental and social dimensions of the patient’s life. Quality of life refers to patients subjective perceptions of the effect of HF on their activity of daily living. Overall quality of life is subjective and individualized. Research is limited regarding the prediction of 30 day hospital readmissions and the use of self-reporting tools among Heart failure (HF). It is important to understand the variables associated with healthrelated quality of life (HRQOL). Purpose: The purpose of this project was to examine the relationship between self-reported Health related quality of life (HRQOL) to 30 day hospital re-admission rates among patients with HF as measured by the Minnesota Living with heart failure questionnaire (MLHQ). The independent variables in this study is quality of life; the dependent variable is 30-day hospital readmission rate. Research Question: What is the relationship between health related quality of life to 30 day hospital readmission rates among patients with diagnosis of heart failure? Hypothesis: There will be a positive correlation between increase in health related quality of life challenges as measured by the Minnesota Living with heart failure questionnaire (MLHQ) and 30 day hospital readmissions. Methods: A quantitative, descriptive co-relational research design (n=66) was used to examine the correlation between the predictor variable, Health related quality of life, to 30-day hospital readmission rates among patients with HF. The Minnesota Living with Heart failure questionnaire (MLHFQ) was utilized as a self- reporting tool to assess quality of life scores. IRB was obtained from the institution of study, participants who volunteered to participate in the study and met the eligibility criteria were consented and requested to complete the MLHFQ as a self - reported tool. Results: A total of seventy participants were recruited to the study, of which four participants were excluded due to mortality, lack of contactable phone number or having opted for palliative care. An independent sample t-test done to test for relationship between health quality of life and readmission was significant (p <0.05). A one- way ANOVA was calculated comparing the demographic variable to 30 day readmission rates revealed a significant difference between monthly income and readmission (F=2.864, p <0.05) and the number of times patients were admitted in the hospital in the past year to readmissions (F=3.333, p <0.01). These findings support the hypothesis that Health related quality of life is a predictor of hospital readmissions. Conclusions: The results of this study provide Health care providers information about predictors of readmissions among participants diagnosed with HF.
352 Impact of Renal Dysfunction on Periprocedural Outcomes in Patients with Ischemic Cardiomyopathy Undergoing Elective Coronary Artery Bypass Graft (CABG) Aasim Afzal, Tariq Nisar, Aayla Jamil, Aaron Kluger, Joost Felius, Shelley Hall, Parag Kale; Baylor University Medical Center, Dallas, TX Background: Ischemic cardiomyopathy is associated with multiple comorbidities including diabetes, hypertension, hyperlipidemia, and kidney disease. Patients with end-stage renal disease (ESRD) and left ventricular systolic heart failure have a 2-year cumulative survival as low as 33%. Chronic kidney disease (CKD) dramatically increases the Society of Thoracic Surgeons (STS) risk score for CABG. Hypothesis: Patients with preoperative CKD undergoing elective revascularization with CABG for ischemic cardiomyopathy will have worse periprocedural outcomes. Methods: From the 2006-2014 National Inpatient Sample, we identified hospitalizations for systolic heart failure (ICD-9 codes 428.1, 428.X, 428.4X, or 428.9) undergoing CABG (ICD-9 procedure codes 36.1X). Those with acute myocardial infarction (code 410.X) were excluded. Patients were categorized into normal preoperative renal function, preoperative CKD stages 1-4 (diagnosis codes 585.1-4 or 585.9), and preoperative ESRD (diagnosis codes 585.5-6), and compared in terms of demographics, comorbidities, in-hospital mortality, length of stay (LOS), cost of care, and postoperative complications. Trends over time were assessed with the Cochran Armitage and Cuzick tests. Multivariate models were constructed with logistic and linear regression (gamma function) using NIS discharge weights and adjusted for age and comorbidities (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and family history of myocardial infarction). Results: Over the study period, trends showed a decline in in-hospital mortality in normal preoperative renal function and CKD stages 1-4 (p<0.05) groups, but remained unchanged for the ESRD group (p=0.91). Patients with ESRD had greater in-hospital mortality (OR = 3.40; 95% confidence interval 3.04 3.80) than those with normal renal function. LOS remained unchanged in all groups, but patients with ESRD had an average of 7 days longer LOS (6.4 - 7.8) compared to those with normal renal function. Total charges increased over the study period, but hospitalization cost on average was $120,996 more for the ESRD group than patients with normal renal function. Patients with ESRD had increased risk of stroke (OR=2.31; 1.55-2.86), while patients with CKD stages 1-4 had increased odds of post-procedural renal failure (OR=1.84; 1.65-2.05) compared to
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the normal renal function group. Conclusions: Patient with ESRD undergoing CABG for ischemic cardiomyopathy continue to have elevated in-hospital mortality despite an overall improvement in the non ESRD cohorts.
353 Home for the Holidays Campaign to Reduce Seasonal Heart Failure Hospitalizations Tulay Aksoy, Jessica Dekhtyar, Linda Gillespie, Nadine Katz, Benjamin Koo, John Loehner, Andrea Porrovecchio, Jeffrey Weiss, Katherine E. Di Palo; Montefiore Medical Center, Bronx, NY Introduction: Heart failure (HF) is a progressive syndrome and previous studies have shown that HF patients are more likely to be hospitalized during colder winter months. These seasonal variations coincide with holidays and can cause an additional emotional burden on patients, family members, and caregivers. Historically, 1 out of 4 HF patients at our institution experienced multiple hospitalizations during this period compared to 1 out of 5 in all other months. Therefore, we created a Home for the Holidays campaign to engage interdisciplinary care teams (IDT) and patients. We hypothesized that these efforts, in conjunction with existing hospital readmission reduction program interventions, would reduce the 30-day all-cause HF readmission rate. Methods: A readmission rate goal of less than 15% was established for 23 nursing units across 3 hospital campuses within a large, urban academic health system. Units that achieved this goal received recognition and breakfast with senior executive health system leadership. A toolkit consisting of a low sodium holiday menu, education workbook and magnet advertising the post-discharge helpline were distributed in a tote bag to all patients identified with acute decompensated HF (ADHF). IDT members focused on self-care management and early symptom recognition with patients and caregivers, as well as timely follow-up appointments. Results: Between 2014 and 2017 the average 30-day all-cause HF readmission rate for the month of December was 24.3%. In December 2018, 235 patients were admitted for ADHF, 37 patients were subsequently readmitted within 30 days and the readmission rate was 15.7%. The Home for the Holidays campaign contributed to a 35.4% rate reduction (p= 0.046) and 9 units achieved the institutional goal of less than 15%. Conclusions: Implementation of the toolkit, along with enhanced counseling and post-discharge follow-up, successfully reduce HF hospital readmissions. Health systems can easily integrate a seasonal campaign to increase awareness and stimulate transitional care and educational activities to keep patients healthy and at home for the holidays.
354 Multifaceted Care Model for CHF Improves Health System and Patient Economic Outcome Azam Hadi1, Michaelle Callihan1, Samuel Neiswender2, Srinivas Murali1; 1Allegheny, Pittsburgh, PA; 2Allegheny/Highmark, Pittsburgh, PA Introduction: Inconsistent piece-meal care for a chronic multidimensional disease like CHF results in poor clinical outcomes, therefore a chronic disease Care model that provides multifaceted holistic chronic disease management in the post-acute
352 Impact of Renal Dysfunction on Periprocedural Outcomes in Patients with Ischemic Cardiomyopathy Undergoing Elective Coronary Artery Bypass Graft (CABG) Aasim Afzal, Tariq Nisar, Aayla Jamil, Aaron Kluger, Joost Felius, Shelley Hall, Parag Kale; Baylor University Medical Center, Dallas, TX Background: Ischemic cardiomyopathy is associated with multiple comorbidities including diabetes, hypertension, hyperlipidemia, and kidney disease. Patients with end-stage renal disease (ESRD) and left ventricular systolic heart failure have a 2-year cumulative survival as low as 33%. Chronic kidney disease (CKD) dramatically increases the Society of Thoracic Surgeons (STS) risk score for CABG. Hypothesis: Patients with preoperative CKD undergoing elective revascularization with CABG for ischemic cardiomyopathy will have worse periprocedural outcomes. Methods: From the 2006-2014 National Inpatient Sample, we identified hospitalizations for systolic heart failure (ICD-9 codes 428.1, 428.X, 428.4X, or 428.9) undergoing CABG (ICD-9 procedure codes 36.1X). Those with acute myocardial infarction (code 410.X) were excluded. Patients were categorized into normal preoperative renal function, preoperative CKD stages 1-4 (diagnosis codes 585.1-4 or 585.9), and preoperative ESRD (diagnosis codes 585.5-6), and compared in terms of demographics, comorbidities, in-hospital mortality, length of stay (LOS), cost of care, and postoperative complications. Trends over time were assessed with the Cochran Armitage and Cuzick tests. Multivariate models were constructed with logistic and linear regression (gamma function) using NIS discharge weights and adjusted for age and comorbidities (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and family history of myocardial infarction). Results: Over the study period, trends showed a decline in in-hospital mortality in normal preoperative renal function and CKD stages 1-4 (p<0.05) groups, but remained unchanged for the ESRD group (p=0.91). Patients with ESRD had greater in-hospital mortality (OR = 3.40; 95% confidence interval 3.04 3.80) than those with normal renal function. LOS remained unchanged in all groups, but patients with ESRD had an average of 7 days longer LOS (6.4 - 7.8) compared to those with normal renal function. Total charges increased over the study period, but hospitalization cost on average was $120,996 more for the ESRD group than patients with normal renal function. Patients with ESRD had increased risk of stroke (OR=2.31; 1.55-2.86), while patients with CKD stages 1-4 had increased odds of post-procedural renal failure (OR=1.84; 1.65-2.05) compared to
S129
the normal renal function group. Conclusions: Patient with ESRD undergoing CABG for ischemic cardiomyopathy continue to have elevated in-hospital mortality despite an overall improvement in the non ESRD cohorts.
353 Home for the Holidays Campaign to Reduce Seasonal Heart Failure Hospitalizations Tulay Aksoy, Jessica Dekhtyar, Linda Gillespie, Nadine Katz, Benjamin Koo, John Loehner, Andrea Porrovecchio, Jeffrey Weiss, Katherine E. Di Palo; Montefiore Medical Center, Bronx, NY Introduction: Heart failure (HF) is a progressive syndrome and previous studies have shown that HF patients are more likely to be hospitalized during colder winter months. These seasonal variations coincide with holidays and can cause an additional emotional burden on patients, family members, and caregivers. Historically, 1 out of 4 HF patients at our institution experienced multiple hospitalizations during this period compared to 1 out of 5 in all other months. Therefore, we created a Home for the Holidays campaign to engage interdisciplinary care teams (IDT) and patients. We hypothesized that these efforts, in conjunction with existing hospital readmission reduction program interventions, would reduce the 30-day all-cause HF readmission rate. Methods: A readmission rate goal of less than 15% was established for 23 nursing units across 3 hospital campuses within a large, urban academic health system. Units that achieved this goal received recognition and breakfast with senior executive health system leadership. A toolkit consisting of a low sodium holiday menu, education workbook and magnet advertising the post-discharge helpline were distributed in a tote bag to all patients identified with acute decompensated HF (ADHF). IDT members focused on self-care management and early symptom recognition with patients and caregivers, as well as timely follow-up appointments. Results: Between 2014 and 2017 the average 30-day all-cause HF readmission rate for the month of December was 24.3%. In December 2018, 235 patients were admitted for ADHF, 37 patients were subsequently readmitted within 30 days and the readmission rate was 15.7%. The Home for the Holidays campaign contributed to a 35.4% rate reduction (p= 0.046) and 9 units achieved the institutional goal of less than 15%. Conclusions: Implementation of the toolkit, along with enhanced counseling and post-discharge follow-up, successfully reduce HF hospital readmissions. Health systems can easily integrate a seasonal campaign to increase awareness and stimulate transitional care and educational activities to keep patients healthy and at home for the holidays.
354 Multifaceted Care Model for CHF Improves Health System and Patient Economic Outcome Azam Hadi1, Michaelle Callihan1, Samuel Neiswender2, Srinivas Murali1; 1Allegheny, Pittsburgh, PA; 2Allegheny/Highmark, Pittsburgh, PA Introduction: Inconsistent piece-meal care for a chronic multidimensional disease like CHF results in poor clinical outcomes, therefore a chronic disease Care model that provides multifaceted holistic chronic disease management in the post-acute