Congestive Heart Failure Case Study

Nearly 5.1 million people in the United States have been diagnosed with heart failure. Yet so many people don’t have a clue what it is until they have been diagnosed with it. Congestive Heart Failure, or CHF, is a disease that has many symptoms, can be tested and treated, has several causes, and can be avoided.

Congestive heart failure is a growing chronic condition in the United States that accounts for over one million hospitalizations and is responsible for 27% of patients with heart failure on Medicare are readmitted with 30 days of discharge (Hines, Yu & Randall, 2010). The intensity of the disease process poses a financial strain on both the patient and the payers, especially Medicare, as 10 per 1000 population are 65 years or older and therefore a Medicare beneficiary (Mozaffarian et al., 2015). Consequently, in order to gain control over this chronic disease and its cost burden, the government and policy makers have shifted the responsibility to the health care facilities through the creation of policies that affect hospital reimbursement based on readmission rates. As a member of the quality team at my facility, the Hospital Readmissions Reduction Program deeply impacts my practice and encourages the hospital as a whole to focus on improving multidisciplinary collaboration in pursuit of quality patient care, resulting in better outcomes and decreased readmissions.

emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. Journal Of The American Geriatrics Society, 57(3), 395-402. doi:http://dx.doi.org/10.1111/j.1532-5415.2009.02138.x

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

A hospital readmission is defined as one that occurs when a patient is admitted to a hospital within a specified time period after being discharged from an earlier (initial) hospitalization. For Medicare, this time period is defined as 30 days. Some of the quality care issues arise within the hospital among staff and also at home after patient discharge. Some of the highest rates of readmission within the 30 days are related to some of the following factors: complications from treatments during a hospital stay, inadequate treatment/inadequate care, coordination and follow up care at home and unexpected worsening of the disease after discharge from the hospital. Patients often face challenges with medication compliance and administration, not understanding the nature of their disease, and also where to get their questions answered once at home. The health care system has come to the conclusion that most of these issues is the leading factor in patient readmission. The most cost efficient solution to the problem of avoidable readmissions is patient education and after discharge follow up. Providing discharge instruction pamphlets to patients is not adequate enough information to yield results. Often times it is left with the patient’s belongings in a bag and never read. This gap in quality care is costing hospitals

The diagnosis is made when an ejection fraction of less than 40% is found during an echocardiogram test. Patients with known systolic heart failure and current or prior symptoms are Stage C. Most common symptoms include, shortness of breath, fatigue and reduced ability to exercise. Stage D is patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care. Other risk factors for heart failure are some diabetes medications, sleep apnea, congenital heart defects, viruses, and irregular heartbeats. Heart Failure can be treated and managed but not cured. It is a chronic condition.

With heart failure, increasing in incidence in the United States, hospital readmission rates are being scrutinized to save money, especially for Medicare beneficiaries. Over 5 million people in the United States are living with heart failure, defined as “a condition in which the heart cannot pump enough blood and oxygen to support other organs in the body” (CDC, 2013). Heart failure affects 2.4% of the United States population with nearly 12% of both women and men 80 years and older having heart failure (Heidenreich, P. A., Albert, N. M., Allen, L. C., Bluemke, D. A., Butler, J., Morrow, G. C., Ikonomidis, J. S., et al., 2013). Heidenreich et al (2013) project that by 2030, heart failure will affect over 8 million Americans, with 2 million of those being ages 80 years and older. Heart failure is one of three conditions to be included in the Centers for Medicare and Medicaid Services (CMS) reimbursements that hospitals are penalized for if the hospital experiences an excess amount of readmissions within 30 days of the initial hospitalization due to the disease.

Congestive Heart Failure (CHF) and Heart Failure (HF) are serious problems in regards to hospital re-admissions especially regarding the sixty-five year old population. Data demonstrates approximately over 670,000 individuals each year are diagnosed with CHF, along with that there are 6 (six) million Americans affected with CHF. Hersh, Masoudi, and Allen (2013) described readmissions of patients with CHF is increasing by 25% within thirty days of discharge from the hospital. This creates a huge impact on the taxpayers and patients due to the increasing percentages being re-admitted into the hospitals (Post discharge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Re-admission, 2013). The problem is to identify a plan to decrease the CHF/HF hospital re-admissions into the especially regarding the 65 (sixty-five) year olds and older, in spite of efforts from the hospital staff providing guidelines and nursing education regarding CHF/HF signs and symptoms.

Nationally 21.9% percent HF patients were readmitted within the thirty days of hospital discharge (30-day readmissions & deaths by medical condition, 2016). According to Walvaren, et al. (2011) up to 75% of the 30-day readmissions are preventable. HF hospital readmissions at Oklahoma University Medical Center (OUMC) are higher than the national rate. When compared to more than 1000 teaching hospitals the most recent records from OUMC show HF readmission rates excluding chemotherapy, dialysis, radiotherapy, rehab, mortality, transfer to other facility, and AMA, at 26.39% ("% 30 Day Readmissions," 2016). Unplanned 30-day readmissions in patients with heart failure lead to poor patient prognosis, deterioration of patient health

A new study released March 16, 2016 by Kaiser Permanente found that heart failure patients had a 19% lower risk of being readmitted to the hospital within 30 days when they were followed up within 7 days of being released from the hospital. The Heart Failure Management program aims to provide early follow-up within one week either by telephone or by office visit if necessary. According to the study, 45 percent of the telephone calls were made by non-physician providers who are qualified to adhere to an outpatient heart failure treatment protocol. Protocols have been established and approved by the participating cardiologists in the community and are evidenced-based driven so that patients will be receiving the best care possible.

Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013). Congestive heart failure continues to account for more health care cost and readmissions than any other illness. The increase in the prevalence of CHF is contributed to the percentage of elderly population. Adherence to performance measures can increase patient outcomes (Mazimba, Grant, Parikh, Mwandia, Makola, Chilomo, Redko, & Hahn, 2012).

Acute-decompensated heart failure (ADHF) is one of the most frequent diagnoses in patients who attend emergency departments (EDs) worldwide, especially in Western countries1,2. In Spain, ADHF constitutes the leading cause of medical hospitalization through EDs3. Despite the substantial resource and economic implications of hospitalization, the final decision of emergency physicians to admit ADHF patients mainly relies on their subjective and personal clinical experience rather than on objective-supported evidence4,5. This decision is complex and challenging, as a wide spectrum of clinical presentations ranging from minor forms of decompensation to life-threatening illness can be observed in ADHF, and these are often complicated by the presence

This literature review has been conducted with ten primary research articles and or/systematic literature reviews to draw a conclusion to the clinical question: what is the best evidence based nursing practice in relation to reducing hospital readmissions in patients with chronic heart failure. Heart failure patients have multiple hospital illness, due to their condition being undermanaged; majority of reasoning for readmissions can be prevented (Lambrinou, Kalogirou, Lamnisos & Sourtzi 2011). Kalogirou et al. (2011) states the patient’s lack of knowledge regarding their disease and non-adherence to their medications, and inability to detect signs and symptoms of decomposition of diseases. Along with gaps in health care result in frequent, very preventable hospital re-admissions. In relation to what is the best evidence based nursing practice in relation to reducing hospital readmissions in heart failure patients the literature studied draw on three common themes a multidisciplinary approach, nurse-led patient education and nurse-led telecommunication.

Movement of patient’s between healthcare settings or even within a single healthcare setting is recognized as a transition of care. Because of the number of transitions of care that occur during an episode of care and the opportunity for communication breakdowns at each transition point, patients are at increased risk for poor outcomes. Along with communication breakdowns, lack of understanding over diagnoses, medication regimens, self-care and follow-up instructions are also associated with poor transitions of care. As a result, poor transitions of care have been associated with readmissions occurring within 30 days of discharge. Readmissions for certain chronic illness, specifically, Heart Failure (HF), Acute Myocardial Infarction (MI),

Congestive heart failure is a chronic disease that requires daily monitoring and life style management. Affecting the elderly, and their family the adjustment is a challenge. Daily life skills include the monitoring of daily weights, intake and output, and a low sodium diet. The person with congestive heart failure is generally admitted to the hospital for medication adjustments when their symptoms increase. The patient is often times short of breath, with a decrease in energy and an increase in their weight. The patients are generally elderly 60-65 years of age or older, and when comparing African Americans to Caucasians the African Americans have a 1.5 greater chance of developing heart failure ("Heart Failure," 2017). The