According to the Centers for Disease Control and Prevention (CDC), about 6.2 million people in the U.S. have heart failure (HF) — and that number is only increasing. The American Heart Association predicts that nearly 8 million Americans are estimated to be living with HF by 2030.
Hospitalization rates for patients with congestive heart failure (CHF) are estimated to be 18 per 100,000, leading to 700,000 inpatient admissions per year. Heart failure was among the top five conditions at index admission with the highest number and highest rate of readmissions for Medicaid and self-pay/no-charge stays, according to the Agency for Healthcare Research and Quality (AHRQ).
This research also shows that approximately half (48.5%) of all readmissions is associated with 20 principal diagnoses at index admission. Of these, four circulatory system diseases at index admission—heart failure, cardiac dysrhythmias, acute myocardial infarction, and cerebral infarction—constituted 11.6% of readmissions. Heart failure was also among the five conditions at index admission with the most readmissions for each expected payer: Medicare (7.8%), Medicaid (4.3%), private insurance (2.8%), and self-pay/no charge (3.7%).
So, it’s no surprise that the Centers for Medicare & Medicaid Services (CMS) included heart failure in its Hospital Readmission Reduction Program (HRRP). Let's take a look at what can be done to reduce the readmission rate of CHF patients, starting with the factors that influence readmission.
Factors Associated with Heart Failure Readmission
Heart failure is a complex condition that becomes increasingly common with age. As such, several factors contribute to heart failure readmission.
A study published in Frontiers in Pharmacology found that noncompliance with therapeutic interventions was associated with readmission for HF patients. Forty-two percent of patients were noncompliant, and 72% had financial issues, which can cause medication non-adherence.
Other factors that contribute to heart failure readmissions include:
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Inadequate treatment
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Drug side effects
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Lack of social support
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Comorbidities
So, what is often missing from discussions about the readmission rate of CHF patients, you ask? The patient experience. One qualitative analysis of patient perspectives showed that patients highlighted a variety of contributing factors for readmission, which were “multi-dimensional in nature, with any single reason rarely given.” The four common themes included:
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Symptom focused (rather than diagnoses based) reasons
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Unavoidable progression of HF
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Self-blaming for behaviors related to self-care
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Healthcare system failures, including premature discharge from index hospitalization
Understanding which factors hospitals and health system providers can influence is the first step to implementing an effective readmission reduction strategy targeting this group of patients.
How to Reduce Hospital Readmissions for CHF Patients
Hospitals and health systems can reduce heart failure readmissions by following these steps:
1. Improve patient education material
When patients are discharged from the hospital, they should understand their condition and how to manage it. Patients are typically given disease handouts. However, that does not mean they have read it or understand the material. A study from Brown University School of Public Health indicates that patients only remember about 49% of the information their doctors give them without prompting.
Approximately 80 million adults in the U.S. are estimated to have limited or low health literacy. Low health literacy is associated with patients who have lower incomes. This population has a high HF readmission rate. Providing Medicaid beneficiaries with written educational material as simply as possible can help improve understanding.
2. Use the teach-back and show-me methods
The teach-back method goes hand-in-hand with health literacy. This method asks patients to explain health information in their own words. This can help providers understand how well they have explained the information. Similarly, the show-me method asks patients to demonstrate their ability to follow instructions. If the patient is unable to complete either method, providers should explain things again using a different approach.
3. Manage and reconcile medications
Although medication plays an important role in managing CHF, it can also cause adverse effects. Not only can certain medications increase the risk of heart failure and other heart problems, including diabetes and blood pressure medications, but older HF patients are often prescribed 10 or more medications. This can cause adverse effects or reactions.
Patients should receive medication reconciliation post-discharge (MRP) to reduce the risk of medication-related readmissions. Medication reconciliation is the process of creating the most accurate list possible of all the medications a patient is taking. This helps ensure the patient receives the correct medication at all transition points during their hospitalization.
Pharmacists skilled in medication management, such as clinical pharmacists, can answer any questions or concerns patients have. They are also in the best position to perform medication reconciliation, offering strategic approaches to medication that reduce complications and help improve patient outcomes.
4. Leverage data to identify high-risk patients
Risk-prediction models can help providers identify patients at risk for readmission. A study published in the Journal of Pharmacy and Bioallied Sciences collected data for HF patients over a six-month period to determine the risk factors that may be responsible for putting a patient at greater risk of readmission due to HF. Multiple factors significantly increased the risk of multiple readmissions within a 12-month period. These included four or more prescribed chronic medications and a more than twice daily dosing regimen.
Researchers developed a predictive model for unplanned readmission for HF patients using recommendations of validated published data. The model had a specificity of about 82%, a sensitivity of about 74%, and an overall accuracy of about 73%. Using the model, the hospital was able to prevent early readmissions, identify patients with HF at risk of readmission, and improve discharge planning.
5. Follow up with patients post-discharge
Connecting with patients shortly after they have been discharged can help reduce the risk of readmission. It can also help physicians check the patient’s well-being and review discharge instructions. Physicians can also address any issues that might cause an adverse outcome and potentially lead to readmission.
The American Heart Association created “Target: Heart Failure” to provide healthcare professionals with clinical tools to better address HF. These tools include:
- Telephone follow-up form
- Readmission checklist
- Discharge checklist
- 30-day Yale Core risk calculator
Get Help with Medication Management to Reduce Readmissions
By identifying the factors contributing to CHF readmissions, hospitals and health systems can take steps to intervene at the appropriate point in the patient’s care journey. But knowing how to reduce hospital readmission rates is only the first step. Implementing best practices to achieve improvement requires a multi-pronged approach. Considering the sheer number of medications likely to be prescribed to patients with CHF, medication management and medication reconciliation, including MRP, must be weighed heavily in the approach to reduce the readmission rate of CHF patients.
Are you properly prioritizing medication management for patients with the highest risk of readmission? Cureatr can help you strengthen efforts without burning out your team. Learn about our strategies for condition-specific comprehensive medication management.
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