The impact of the heart failure health enhancement program: A retrospective pilot study

Abstract

Background: Heart Failure (HF) is a health care issue associated with high rates of morbidity and mortality, costing the United States billions of dollars annually. Current healthcare reform requires managing transitions from acute care to home so that the disease is managed effectively and readmissions prevented. Routine HF discharge care includes education regarding prescribed medications, weight monitoring, dietary restrictions, and symptom exacerbation. The Heart Failure Health Enhancement Program (HFHEP) was developed to provide outpatient education and support to assist patients in implementing practices designed to decrease exacerbations of heart failure and prevent readmissions.

Purpose: This retrospective pilot study evaluated the effectiveness of the HFHEP intervention after completion of the program’s first year. The specific aims of the study were to examine differences in inpatient readmission rates within 30 days and from 31 to 90 day for individuals diagnosed with HF following hospital discharge during the intervention year and the year prior to the intervention, and to examine differences between participants and non-participants of the HFHEP program during the intervention year. An additional aim was to determine whether individuals’ demographic characteristics and left ventricular ejection fraction (LVEF), as a measure of severity of illness, differed between the two periods and influenced participation in the HF program and readmission outcomes. The final aim was to determine if common barriers prevented participation in the program.

Methods: The study, which utilized a retrospective design, was conducted at a 118 bed community hospital in the Midwest. Two hundred eleven patients generated 266 acute care stays with a primary diagnosis of HF during the two years. Intervention year data was compared to data from the year prior to the intervention. Descriptive statistics and chi square analysis were used to analyze the data.

Results: While not achieving statistical significance, there were fewer readmissions within 30 days of discharge during the intervention year (5%) compared to the non-intervention year (9.6%) representing a nearly 50% decrease in readmissions. No statistically significant findings were demonstrated between individual’s LVEF and 30-day re-
admissions, 31-90 day readmissions, or program participation. Major barriers to participation included nursing home residency, lack of referral, patient refusal, patient expiration, and no transportation to the program. An unexpected finding was that 14% of the patients had LOS exceeding the expected LOS for HF.

Conclusions: The HFHEP was an effective intervention to prevent 30-day readmission for patients discharged with a primary diagnosis of HF; however, the number of participants was insufficient to achieve statistical significance. Recommendations of the study include adding a tele-monitoring component to the intervention, automating the referral process to capture all potential participants, providing educational programs for nursing home and assisted living personnel regarding best practices in the management of HF, and further investigation of reasons for patient refusal to participate in the HFHEP.  Recommendations for future research are also discussed.