Evidence-based Strategies to Reduce Readmission in Patients With Heart Failure

Sun Min Kim, DNP, BC-FNP; Hae-Ra Han, RN, PhD

Disclosures

Journal for Nurse Practitioners. 2013;9(4):224-232. 

In This Article

Abstract and Introduction

Abstract

Preventable hospital readmission is an increasingly prominent target in policy discussions. It is crucial to find feasible strategies for each health care system to further reduce heart failure readmissions cost-effectively and improve patient outcomes and health care performance. An electronic database search for relevant articles published in English before March 2012 was done. Nineteen articles of evidence-based strategies for reducing readmissions were included in this review. A variety of measures have been taken in health care, but the conclusive evidence of improved clinical outcomes and costs for such programs have had disparate results in different systems.

Introduction

Heart failure (HF) is a major and increasing public health problem that affects patients, families, and communities. Approximately 5.7 million Americans have HF, with 10 per 1,000 new cases being reported each year after age 65.[1] Over the past 25 years, the annual number of hospitalizations has increased from 800,000 to over 1 million for HF as a primary diagnosis and from 2.4 to 3.6 million for HF as a primary or secondary diagnosis.[2]

Despite advances in HF-related medical care, frequent readmission is of particular concern when treating these patients. Approximately 50% of HF patients are rehospitalized within 6 months of discharge, and 70% of the rehospitalizations are related to worsening of previously diagnosed HF.[3,4] Recent estimates suggest that almost a fifth of Medicare beneficiaries discharged from a hospital are readmitted within 30 days.[5] The direct costs of HF are estimated to have been $39.2 billion in 2012, with more than 1.1 million hospitalizations and nearly 3.4 million ambulatory care visits contributing to costs.[1] According to the Medicare Payment Advisory Commission, the estimated annual cost of unplanned readmissions for HF is $17.4 billion.[6]

The Affordable Care Act includes several important measures aimed at bending the HF cost curve. One such mechanism is to bundle payments for a given episode of care. This strategy gives hospitals a fixed amount of money for treating a given condition for a defined period.[7] The Centers for Medicare and Medicaid Services (CMS) also has announced that it will decrease reimbursement or add penalties for patients who require readmission for any cause within 30 days of their initial HF admission.

Because of these changes, many hospitals and health care systems are focusing on improving performance and patient outcomes in HF—with a particular emphasis on how to manage the condition to prevent readmissions, decrease costs, and improve quality of life. To this end, this article critically reviews the current literature on usual practices for preventing HF readmission and appraises available strategies to reduce readmission.

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