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Heart Failure Readmissions

There were more things going on in this meeting; however, we had this morning a superb session about the problem of admissions and readmissions. A very beautiful talk by Peter Pang, who is in the Department of Emergency Medicine at Northwestern [University Feinberg School of Medicine], addressed the issue of patients with acute heart failure patients presenting through the emergency department -- most of which we know. We know most of these patients get admitted to the hospital, and he reports that there is a population that if you can risk-stratify them, you may be able to treat them in the emergency department or move them into a 24-hour observation unit, treat them adequately, allow some time for patient education and assessment of comorbidities, and then get them seen pretty quickly.

We also had another wonderful talk about the environment that these patients go back to. We live in the environment of the hospital and the clinic, but the patients are in the environment of reality. And reality is their community, it may be their city, it may be their home -- and they are going back to that environment, which perhaps fostered the admission to start with. There may be lack of ability to get their drugs, lack of ability to get good food and low-sodium foods, and lack of adequate follow-up. So we have many problems to handle with this issue of readmission, but what it has done is it has made us focus on the problem and the multiple areas that we must intervene on.

We had a quality paper published in Circulation [Cardiovascular Quality Outcomes] by Elizabeth Bradley, where we sent out a survey to hospitals participating in the Hospital to Home [H2H] National Quality Improvement Initiative or the State Action on Avoidable Rehospitalizations Initiative [STAAR]) to find out what strategies made sense.[3] Not surprisingly, the strategies that made sense were those that fostered communication, that fostered more nurses doing medication reconciliation, that allowed communication back to the primary care physician who would eventually own that patient, and partnering with community physicians by whatever means. And the strategies that were most successful were the ones that had 1 or more interventions, so don't give up if 1 intervention alone may not have worked. You may need to tackle that problem in 2 or 3 different places.

Guidelines

For my next blog, I am going to be talking about the prevention guidelines and the obesity guidelines in the soon-to-come-out hypertension advisory. JNC8 (the Joint National Committee's eighth report) will now come out as an American Heart Association/American College of Cardiology advisory or statement on hypertension, and so for that future blog, I leave you at sessions in Dallas.

Have a great day. This is Ileana Piña, signing off.

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