The Severity Of Heart Failure

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

Heart Failure affects nearly 5.8 million people in the United States. The American Heart Association reports that the total economic cost of heart disease and stroke in 2011 was $320.1 billion. ("Efforts to Prevent Heart," 2015). More Medicare dollars are spent for the diagnosis and treatment of heart failure than for any other diagnosis (Schneider, O'Donnell, & Dean, 2011). Hospital admissions for heart failure are very common, especially among Medicare aged patients, and heart failure hospital readmissions are a major contributor to rising healthcare costs. Evidence suggests that factors influencing readmission rates for heart failure patients include knowledge deficits in nursing education, standardized patient education, and transitional

Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting

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.

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

Policy makers are constantly searching for new innovative ways to increase quality patient care and lower Medicare program spending. One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to the hospital. Heart Failure patients are on the top of that list. Readmission refers to a patient’s being hospitalized within 30 days of an initial hosptial stay. This seems to be an indicator of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care.

Rising health care cost and stricter regulations for insurance reimbursement plans have pushed health care leaders to re-evaluate health care services. One focus is reducing hospital readmission rates for chronic disease process (Bos-Touwen et al, 2015). Congestive heart failure is one of the leading causes of hospital readmission (Cubbon et al, 2014). Fifteen million people worldwide have a diagnosis of CHF. In addition, 15-20% of those with the diagnosis of CHF are hospitalized yearly (Sahebi et al, 2015). In 2010, 40 billion dollars was spent on health care needs for CHF patients. Seventy percent of the resources were for hospital services (Siabani, Driscoll, Davidson, and Leeder, 2014). The need for streamline healthcare for CHF patients is imperative to improve overall patient outcomes and reduce the amount of hospital readmission rates.

Heart failure (HF) is one of the leading causes of hospital admissions and readmissions in the United States (Desai & Stevenson, 2012; Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). It is a condition that accounts for a very high morbidity and mortality (Bakal, McAlister, Liu, & Ezekowitz, 2014). Every hospital admission for heart failure patients results in disease progression and poor prognosis. For chronic HF patients, a hospitalization is one of the strongest prognostic predictors for increased mortality (Gheorghiade et al., 2013). Factoring in re-hospitalizations, especially at 30-day to 90-day mark, it is increasingly detrimental to patient prognosis.

Approximately 2-3 million Americans, more than one percent of the population, are currently affected by this medical problem with numbers increasing frequently (Drug Store News, 1997). Congestive heart failure tends to be more common in the elderly, men, and also African Americans. Congestive heart failure has become the most common cause for current hospital admissions. Among causing prolonged hospital stays congestive heart failure has a very high mortality rate, which has declined since recent medical advancements.

Congestive heart failure has become a leading health issue in the United States and around the world especially among the elderly, overweight, and men. According to the Centers for Disease Control and Prevention (CDC, 2013) website, 5.1 million people in the United States have heart failure which leads to over $32 billion dollars in health care services. McHugh and Ma (2013) report that 23.3% of heart failure admissions were readmitted within 30 days due to non-compliance (p. 52). According to the Centers for Medicare & Medicaid Services (CMS, 2015) website, the Hospital Readmission Reduction Program requires CMS to reduce payments to Inpatient Prospective Patient System Hospitals with excess readmissions for heart failure. Effective October

When the heart begins to fail, mechanisms are activated to compensate for the impaired function and maintain the cardiac output. The primary compensatory mechanisms are Frank –Starling mechanism, neuroendocrine responses including activation of the sympathetic nervous system and the renin- angiotensin-aldosterone system, and ventricular hypertrophy. Decreased cardiac output initially stimulates aortic baroreceptors, which in turn stimulate the SNS. SNS stimulation produces both cardiac and vascular responses through the release of norepinephrine. Norepinephrine increases heart rate and contractility by stimulating cardiac beta- receptors. Cardiac output improves as both heart rate and stroke volume increase. Norepinephrine also causes arterial

Considered a major health problem in the United States, heart failure (HF) is a syndrome involving insufficient pumping and/or filling of the heart (Lewis, Heitkemper, Dirkson, & Bucher, 2014). As HF progresses, the heart cannot continue to meet the oxygen demands of the body’s tissues due to a decreased cardiac output. Acute HF and chronic HF have replaced the term congestive heart failure (CHF) since not all HF patients experience pulmonary congestion, but CHF is still commonly used in the clinical setting (Lewis et al., 2014). Regardless of the terminology, HF typically results in poor outcomes and a high incidence of hospital readmissions.

Heart failure occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as coronary artery disease.

The signs and symptoms of heart failure depends on the type and severity of heart failure. Some of the most common symptoms of heart failure include extreme fatigue, dyspnea, dizziness and confusion, weight changes, edema and tachycardia.10

Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged 65 and older (Roger et al., 2013). HF is a major health care issue with a current prevalence of over 5.8 million in the USA and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five and carries substantial morbidity and mortality. Despite advances in management, the 5-year mortality rivals that of many cancers.