HFSA: HF readmissions could be even lower

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BOSTON--Fifty-four percent of overall healthcare costs are related to rehospitalizations. While less than half of rehospitalizations are related to heart failure (HF), integrated strategies that could prevent HF rehospitalizations currently are being underutilized, Prakash C. Deedwania, MD, chief of cardiology at the University of California, San Francisco School of Medicine, said during a presentation Sept. 19 at the 15th annual Heart Failure Society of America’s (HFSA) scientific sessions.

“While evidence-based therapies have reduced HF mortality, readmissions rates have increased within this same period of time,” Deedwania offered.

He noted that only about one-third of readmissions are related to HF; two-thirds are related to causes where HF is either the primary or secondary etiology.

While Deedwania offered that the rate of a first hospitalization on 30-day mortality is 12 percent, one-year mortality is 34 percent within these patients.

Additionally, Deedwania noted that the majority of readmissions can be preventable. He also noted that noncompliance of medication usage and diet noncompliance both account for 24 percent of these readmissions.

Deedwania noted that the leading causes of readmissions are: uncontrolled hypertension, non-compliance, lack of proper education, infections and arrhythmias. He noted that atrial fibrillation (AF) has become an increasing problem particularly due to device problems such as infection or shock.

While AF and HF are large culprits of hospital readmissions, Deedwania noted that depression, dementia, cerebrovascular disease and Alzheimer’s disease have become factors that also lead to high readmission rates.

While readmissions are prevalent, there are some predictors. These include a prolonged length of first hospital stay, increased age or ICD shock.

“Providing heart failure patients with one-hour of education could significantly decrease readmissions,” Deedwania offered. “Educating patients on drug therapy and compliance could help decrease the readmission rates for heart failure patients.”

Nearly one in four patients are hospitalized with HF within three days of discharge, Deedwania noted. While process of care tools are helpful to decrease 60- to 90-day hospital mortality rates, these tools are not widely adopted.

“Many of these readmissions are preventable,” Deedwania concluded, “however, effective strategies to prevent rehospitalizations remain underutilized.”