CHF and Managing Post Hospital

Transcription

1 CHF and Managing Post Hospital Nancy Mesiha, MD, FACC, MACM PD, Cardiovascular Fellowship Program St John Hospital & Medical Center Cardiology Associates of Michigan S

2 No Disclosures

3 Objectives S Statistics S Management Strategies that may help to reduce HF re-hospitalization

4 Statistics & Facts S 5.8 million in the United States S 1 million hospitalization annually S 6.5 million hospital days S Rates of hospitalization continue to rise S Half of Heart Failure patients have preserved EF S Heart failure readmission is a quality metric and an outcome measure in HF trials

5 From: Rehospitalization for Heart Failure: Problems and Perspectives J Am Coll Cardiol. 2013;61(4): doi: /j.jacc Figure Legend: Rehospitalization After an Admission for HF The number of hospitalizations within 30 days, 31 to 60 days, and more than 60 days after a hospitalization for heart failure (HF) in the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) trial. The reasons for hospitalization are represented in each bar. Non-CV hospitalization = noncardiovascular hospitalization; Non-HF CV hospitalization = non-heart failure cardiovascular hospitalization. Date of download: 9/9/2015 Copyright The American College of Cardiology. All rights reserved.

6 From: Rehospitalization for Heart Failure: Problems and Perspectives J Am Coll Cardiol. 2013;61(4): doi: /j.jacc Figure Legend: Mode of Death After a HHF The number of deaths within 30 days, 31 to 60 days, and more than 60 days after a hospitalization for heart failure in the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) trial. Their mode of death is represented in each bar. HF death = death from heart failure; SCD = sudden cardiac death. Date of download: 9/9/2015 Copyright The American College of Cardiology. All rights reserved.

7 Heart Failure u Outpatients with Chronic Heart Failure S Prognosis has significantly improved S Prognosis and QOL improves with GDMT u Hospitalization for Heart Failure S Different Clinical Course and Prognosis S Mortality 15% and 30%, 30 and 60 days post discharge S Among Medicare beneficiaries with HF, 27% are re-hospitalized within 30 days.

8 Heart Failure Progression

9 Can We Succeed with Heart Failure

10 Reducing Readmission S Managing Congestion S Pharmacotherapy S Device therapy S Ischemia/ Valves/ Arrhythmias S Hypertension S Comorbidities

11 Transition of Care S Post-Discharge Period ( Vulnerable Phase) S Early Post Discharge Visit phone call, visiting nurse, office visit, telemonitoring and weight management. S Comprehensive approach, not merely focusing on fluid management

12 What Constitutes a Comprehensive Follow UP

13 From: Rehospitalization for Heart Failure: Problems and Perspectives J Am Coll Cardiol. 2013;61(4): doi: /j.jacc Table Title: Components of Early Post-Discharge Follow-Up Date of download: 9/9/2015 Copyright The American College of Cardiology. All rights reserved.

14 Team-Based Approach

15 How come Mrs. Smith is back? S She didn t take her medicines S She drank too much water S She couldn t fill her prescriptions S She ate too much salt S She likes living in the hospital S She is a Frequent Flyer

16 Causes of 30 days readmission S Factors beyond anyone s control S Disease Specific Factors S Patient Factors S Physician Factor S System Factors

17 Conclusions S Among patients hospitalized for Heart Failure: S S S S High mortality and readmission rates Need early follow up Comprehensive approach Team Based Approach S Hospitals with higher rates of early follow-up: S Lower risk of 30-day readmission S Future studies should evaluate the effects of early follow-up on readmission

18 To Reduce Heart Failure Admission Comprehensive Plan S Early Identification of HF patients S Education of patients and family S Evaluate the risk S Eliminate medications S Early follow up S Expend resources

19 CHF and Managing Post Hospital Nancy Mesiha, MD, FACC, MACM PD, Cardiovascular Fellowship Program St John Hospital & Medical Center Cardiology Associates of Michigan S