HF patients discharged with euvolemia see fewer readmissions

Heart failure patients who are discharged from the hospital before they reach euvolemia—a healthy balance of blood in the body—are more likely to be readmitted in both the short- and long-term, according to research published in the American Journal of Cardiology this month.

Jonathan Davis, MD, MPHS, of Oregon Health and Science University, and colleagues led the retrospective study of 100 acute decompensated HF patients, whose discharge summaries were collected over a one-year period. Thirty-day readmissions typically fall between 19 and 25 percent for acute heart failure patients—something the authors said accounts for 80 percent of the domestic annual cost of HF.

“Patient education or attentive follow-up care may address this problem, thus recent interventions have focused on the interface between inpatient and ambulatory care, including tele-monitoring, intensive nursing support, expedited follow-up and improved patient education,” they wrote. “Less inquiry has been directed at the congested inpatient, particularly at the critical point of decongestion or ‘discharge readiness.’”

Exam improvement, dyspnea improvement, hemoconcentration and changes in NT-proBNP all exist to guide inpatient decongestion, but it’s largely unknown how those factors are documented and could affect outcomes.

Traditional cardiovascular risk factors were common among Davis et al.’s study population, and all-cause 30-day readmission occurred in 18 percent of the pool. Heart failure-related 30-day readmission affected 12 percent of participants.

When it came to discharge summaries (DSs), the authors said, it wasn’t common for physicians to specifically state a patient had reached euvolemia, but when they did, patients were less likely to be readmitted in the future. A DS physical in support of decongestion and discussion of jugular venous pulse were also more common in patients who weren’t readmitted.

“The systematic demonstration of various ‘euvolemia markers’ prior to discharge may improve both transitions of care and the likelihood of a thoughtful discharge assessment,” the authors wrote. “Our findings suggest that discharge prior to euvolemia without satisfaction of these ‘euvolemia markers’ should be strongly discouraged.”

Davis and his colleagues said the trial had limitations, including the fact that it was subject to selection bias as an observational study. Other factors, like financial considerations and a larger sample size, could have improved the research.

“Monitoring decongestion and the assessment of discharge readiness by discharging providers and institutional standardization of discharge criteria and documentation should be studied prospectively to further evaluate the relationship between these practice patterns and patient outcomes,” the authors wrote.