In a time when all other industries are trying to become more efficient, hospitals are building bigger waiting rooms. Health-care costs are skyrocketing, and the federal government is stepping in to try to help.' Everyone knows about the inefficiencies of the current health-care system, but the jury is still out on how to correct the problems. From a provider s point of view, the goal is to take care of the patient in the best way possible and make a living in the process. Although evidence-based medicine has been part of the literature since the 1990s, patients continue to be admitted and readmitted to hospitals at an alarming rate. (2-4)
The statistics for heart failure (HF), in particular, are staggering. HF is the primary reason for hospital admissions in patients older than age 65 years and accounts for more than 1 million admissions each year. Even more frightening is the overall five-year mortality of +++++50%. (5), (6) Research shows that many HF patients who have been hospitalized will be readmitted almost as soon as they are discharged. (7) Of the Medicare patients admitted with HF, approximately 27% will be readmitted within 30 days of discharge, costing Medicare about 517.4 billion each year. (6) The question now is, how do we turn this around?
The only good news is that providers and patients alike are ready for change. Providers are looking for new ways to treat old problems more effectively and not only deliver evidence-based medicine, but actually break down the barriers and get effective treatment to the patient.Which approach is most likely to reduce hospital readmissions for heart failure (HF)? Specialized HF clinics 46% Home Care 35% On-site Clinics 16% Other 3% For more polls, visit www.ClinicalAdvisor/polls Note: Table made from pie chart.
Treatment of HF is based on a multimodal approach and requires patient and provider to establish a partnership that focuses on preventing exacerbations and improving quality of life. Traditional treatment regimens include identifying risk factors, modifying lifestyle, maximizing pharmacologic therapy, and sometimes surgery. (8-10) Risk factors include hypertension, coronary artery disease (CAD), diabetes, and alcohol consumption (Table 1); many of these are modifiable. (8) By far, the most difficult aspect of HF treatment is addressing the lifestyle changes required for any regimen to be successful. Patients may be unwilling to accept the need for them to change their way of life. Some of the required lifestyle changes include losing weight, eating a healthy diet, and exercising daily (Table 2). (8) Medications necessary to support a failing heart include beta blockers, ACE inhibitors, spironolactone (Aldactone), and loop diuretics (Table 3). (8) Patients with more severe symptoms often benefit from inotropes. In some cases, an implantable cardiac defibrillator, cardiac resynchronization therapy, or a heart transplant is necessary to decrease mortality and improve cardiac function. (9), (10)
Education at hospital discharge, with an emphasis on symptom recognition for potential exacerbation, is vital to turning the tide of readmissions. The patient needs to be taught to watch for...