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Heart Failure Readmissions Reduction Intervention Positively Affects Readmissions for HFrEF But not HFpEF
S58 Journal of Cardiac Failure Vol. 21 No. 8S August 2015 Methods: Phone interviews of older ambulatory patients with ICDs identified as high risk for short-term mortality based on risk model incorporating comorbid conditions. Results: Among 110 eligible patients, 51 participated, with mean age 71.3 years, 74.5% male, 82.4% CHF, 61.7% CAD, 44% AF, 47.9% diabetes, 24% CRT devices, 28% prior appropriate ICD therapies. Though nearly half (45%) had undergone an ICD generator replacement procedure in addition to the initial implant, only 39.2% reported that their cardiologist had ever asked them about overall goals of care, and only 9.8% reported that their cardiologist had ever discussed prognosis,. Prioritization of life prolongation versus comfort varied widely (Figure), yet no health care professional discussed the possibility of ICD deactivation for most patients either at the time implant (92.2%) or since implant (82.4%). Accordingly, only a minority of patients were aware that ICDs can be turned off (47.1%), had completed a living will (35.3%), or selected a health care proxy (45.1%). Despite this, overall satisfaction with decision-making was generally high (mean Decision Satisfaction Inventory score of 72, range 0100), and 70.6% indicated that the ICD had greatly or somewhat improved their quality of life. Conclusions: Though patients report generally positive quality of life and satisfaction with decision-making, critical gaps in communication, knowledge, and advance care planning remain unaddressed in many ICD recipients.
Figure 2.
117 Heart Failure Readmissions Reduction Intervention Positively Affects Readmissions for HFrEF But not HFpEF Milena Jani1, Joanna Kingery2, Irmina Gradus-Pizlo1, Azam Hadi1, Marco Caccamo1, Jose Finet1, Adnan Malik1; 1Indiana University School of Medicine, Indianapolis, IN; 2IU Health, Indianapolis, IN Introduction: It is well established that among patients with heart failure (HF), half have heart failure with preserved ejection fraction (HFpEF). Heart failure, regardless of etiology, remains the leading cause of hospitalization among adults O65 years of age, accounting for a total Medicare expenditure exceeding $17 billion. While certain interventions help reduce heart failure readmissions, it is ambiguous whether those interventions can be beneficial in patients with HFpEF. Hypothesis: Implementing strategies to improve admission and discharge follow up will reduce heart failure readmissions in patients with HFrEF and HFpEF. Methods: Retrospective analysis of admissions in our hospital in year 2014 revealed that 897 admissions carried the primary diagnosis of heart failure. The interventions implemented included, palliative care consult, goal-directed medical therapy (GDMT), and initiation of 7 day follow up visits. Readmissions rate were grouped based on the nature of heart failure, HFrEF !40% and HFpEF O40%. Results: Of the 897 readmissions in our hospital in 2014, 66 were due to HF exacerbations, and 165 readmissions had other primary diagnoses but with underlying HF pathology. The majority of readmissions were patients with underlying HFpEF rather than HFrEF. Sixty-one percent (40/66) of the heart failure readmissions were attributed to HFpEF alone, and 71% (117/165) of all-cause readmissions were patients with underlying HFpEF. Regardless of the nature of the heart failure, patients did not differ significantly background interventions; including follow-up appointments post discharge, GDMT, and palliative care consultation. Conclusions: Although the trend was towards reduced 30-day heart failure readmissions, the measures were less effective on those who had heart failure with preserved ejection fraction
118 Health Care Goals, Communication, and Knowledge Among Older ICD Recipients Yaw Adjei-Poku1, Michelle Samuel1, Diane Engorn2, Daniel Habtemariam2, Matthew R. Reynolds3, Susan L. Mitchell2, Daniel B. Kramer1; 1Beth Israel Deaconess Medical Center, Boston, MA; 2Hebrew SeniorLife Institute for Aging Research, Boston, MA; 3Harvard Clinical Research Institute, Boston, MA Background: Initial and replacement implantable defibrillator (ICD) implantation is common in older patients. Despite the importance of defining their health care goals, little is known about the quality of their communication with providers.
Figure 1. Proportion of patients indicatingon Likert scale agreement with statementthat their most important health care goal was life prolongation or comfort, respectively.
119 High Prevalence of Heart Failure (HF) Knowledge Deficits in Hospitalized Chronic Heart Failure Patients-a Single Center Retrospective Analysis of Quality Data Showing a Need for Better CMS Core Measures Michael Pudlo, Sarah Homer, Carl Daniel, Susan Bionat, Andrea Creamer, Sayali Ketkar, Arvind Bhimaraj; Houston Methodist Hospital, Houston, TX Background: Discharge instructions as a CMS core measure (HF-1) has not shown any impact on outcomes and was removed as a quality metric for hospitals. Though the components of heart failure knowledge/ education existed under this core measure, detailed reporting of these individual aspects was not a part of HF-1 core measure. Objective: The purpose of this analysis was to describe the prevalence of heart failure knowledge deficits upon admission to the hospital. Methods: As a part of a pilot quality initiative, three Heart Failure Disease Management (HFDM) Nurse Practitioners (NP) provided screening and intervention for patients with a diagnosis of Congestive Heart Failure (CHF) for two high volume services in our hospital. An initial assessment template was developed by a heart failure task force headed by a heart failure specialist. A part of the assessment was to identify reasons for admission with a focus on knowledge deficits in specific aspects of HF and provide education to improve self-care. The aspects of heart failure knowledge assessed during patient interviews were: 2gm Na diet adherence, fluid restriction adherence, monitoring daily weights, what to do if HF symptoms worsen, physical activity level counseling,
Figure 2.
117 Heart Failure Readmissions Reduction Intervention Positively Affects Readmissions for HFrEF But not HFpEF Milena Jani1, Joanna Kingery2, Irmina Gradus-Pizlo1, Azam Hadi1, Marco Caccamo1, Jose Finet1, Adnan Malik1; 1Indiana University School of Medicine, Indianapolis, IN; 2IU Health, Indianapolis, IN Introduction: It is well established that among patients with heart failure (HF), half have heart failure with preserved ejection fraction (HFpEF). Heart failure, regardless of etiology, remains the leading cause of hospitalization among adults O65 years of age, accounting for a total Medicare expenditure exceeding $17 billion. While certain interventions help reduce heart failure readmissions, it is ambiguous whether those interventions can be beneficial in patients with HFpEF. Hypothesis: Implementing strategies to improve admission and discharge follow up will reduce heart failure readmissions in patients with HFrEF and HFpEF. Methods: Retrospective analysis of admissions in our hospital in year 2014 revealed that 897 admissions carried the primary diagnosis of heart failure. The interventions implemented included, palliative care consult, goal-directed medical therapy (GDMT), and initiation of 7 day follow up visits. Readmissions rate were grouped based on the nature of heart failure, HFrEF !40% and HFpEF O40%. Results: Of the 897 readmissions in our hospital in 2014, 66 were due to HF exacerbations, and 165 readmissions had other primary diagnoses but with underlying HF pathology. The majority of readmissions were patients with underlying HFpEF rather than HFrEF. Sixty-one percent (40/66) of the heart failure readmissions were attributed to HFpEF alone, and 71% (117/165) of all-cause readmissions were patients with underlying HFpEF. Regardless of the nature of the heart failure, patients did not differ significantly background interventions; including follow-up appointments post discharge, GDMT, and palliative care consultation. Conclusions: Although the trend was towards reduced 30-day heart failure readmissions, the measures were less effective on those who had heart failure with preserved ejection fraction
118 Health Care Goals, Communication, and Knowledge Among Older ICD Recipients Yaw Adjei-Poku1, Michelle Samuel1, Diane Engorn2, Daniel Habtemariam2, Matthew R. Reynolds3, Susan L. Mitchell2, Daniel B. Kramer1; 1Beth Israel Deaconess Medical Center, Boston, MA; 2Hebrew SeniorLife Institute for Aging Research, Boston, MA; 3Harvard Clinical Research Institute, Boston, MA Background: Initial and replacement implantable defibrillator (ICD) implantation is common in older patients. Despite the importance of defining their health care goals, little is known about the quality of their communication with providers.
Figure 1. Proportion of patients indicatingon Likert scale agreement with statementthat their most important health care goal was life prolongation or comfort, respectively.
119 High Prevalence of Heart Failure (HF) Knowledge Deficits in Hospitalized Chronic Heart Failure Patients-a Single Center Retrospective Analysis of Quality Data Showing a Need for Better CMS Core Measures Michael Pudlo, Sarah Homer, Carl Daniel, Susan Bionat, Andrea Creamer, Sayali Ketkar, Arvind Bhimaraj; Houston Methodist Hospital, Houston, TX Background: Discharge instructions as a CMS core measure (HF-1) has not shown any impact on outcomes and was removed as a quality metric for hospitals. Though the components of heart failure knowledge/ education existed under this core measure, detailed reporting of these individual aspects was not a part of HF-1 core measure. Objective: The purpose of this analysis was to describe the prevalence of heart failure knowledge deficits upon admission to the hospital. Methods: As a part of a pilot quality initiative, three Heart Failure Disease Management (HFDM) Nurse Practitioners (NP) provided screening and intervention for patients with a diagnosis of Congestive Heart Failure (CHF) for two high volume services in our hospital. An initial assessment template was developed by a heart failure task force headed by a heart failure specialist. A part of the assessment was to identify reasons for admission with a focus on knowledge deficits in specific aspects of HF and provide education to improve self-care. The aspects of heart failure knowledge assessed during patient interviews were: 2gm Na diet adherence, fluid restriction adherence, monitoring daily weights, what to do if HF symptoms worsen, physical activity level counseling,