| Abstrakt: |
Acute heart failure (HF) is a common cause of hospitalization with rates of 2.8 per 1000 for all ages and 13.4 per 1000 for those 60 years of age and older. The transition from inpatient to outpatient care is a vulnerable time, with roughly 25% of patients being readmitted within 30 days. Current guidelines recommend discharge support in the form of a transitional care plan. Large-scale registries have shown that discharge tools are associated with decreased rates of mortality and re-hospitalization. However, prospective studies have yet to identify specific interventions that improve post-discharge outcomes. We aimed to generate a standardized discharge process for patients hospitalized with acute HF. Implementation of a standardized discharge model decreases the rate of discharge medication reconciliation errors, rate of 7-day post-discharge HF follow-up appointments missed, and rate 30-day readmissions for patients >18 years of age admitted for acute HF. A single-center prospective study of 123 patients was conducted over 18 months. Consecutive patients admitted for HF were evaluated over a 2-month period for the pre-intervention (n = 63) and post-intervention (n = 60) groups. A standardized discharge process was executed for 3 months prior to evaluation of the post-intervention group. Interventions included a HF Checklist on admission and discharge, daily heart failure rounds, a standardized discharge summary, and routine discharge updates given to an outpatient cardiology clinic. Primary outcome measurements included the rate of discharge medication reconciliation errors, 7-day HF follow-up appointments missed, and 30-day readmissions. Descriptive statistics were used to analyze pre- and post-intervention groups. Rates of outcomes and frequency percentages were used for categorical variables. Relative risks were calculated with 95% confidence intervals. A total of 123 patients in the pre- and post-intervention groups were analyzed (median age 69 years; 65.9% Female; 49.6% Black, 42.3% White, 4.9% Hispanic, 3.3% Other). The rate of discharge medication reconciliation errors was significantly lower in the post-intervention group compared to the pre-intervention group (RR 0.40; 95% CI, 0.19-0.83; p=0.0144), despite an 8.9% increase in changes made to the baseline medication regimen. The rate of 7-day HF follow-up appointments missed was significantly lower in the post-intervention group compared to the pre-intervention group (RR 0.36; 95% CI, 0.24-0.53; p=0.0001). Lastly, the rate of 30-day readmissions was significantly lower in the post-intervention group compared to the pre-intervention group (RR 0.10; 95% CI, 0.01-0.72; p=0.0224). Among patients admitted for acute HF, implementation of a standardized discharge model for 3 months significantly decreased the rate of discharge medication reconciliation errors, 7-day HF follow-up appointments missed, and 30-day readmissions. We demonstrate the practicality and efficacy of 4 interventions on post-discharge outcomes in this patient population. [ABSTRACT FROM AUTHOR] |
Full Text from ScienceDirect