Readmissions of patients with heart failure are both common and costly. Currently, Centers for Medicare and Medicaid Services (CMS) is penalizing hospitals for excessive readmission rates. A total of 2,610 hospitals in the US will see their Medicare payments docked in fiscal 2015 for having excessive numbers of patients return to the hospital within 30 days of discharge. This is the third year the CMS has instituted the penalties in an effort to promote better outcomes in the nation’s hospitals.
Nearly 1 in 4 patients hospitalized with heart failure are readmitted within 30 days. A substantial portion of readmissions may be avoidable.
Grandin EW, Jessup M. 2015 Oct 6;132(14):1307-10. doi: 10.1161/CIRCULATIONAHA.115.018692. Epub 2015 Aug 27. PubMed PMID: 26316617.
Rethinking the Focus of Heart Failure Quality Measures
This study is an important step toward quantifying the magnitude of the problem faced by providers and patients to achieve an optimal HF medical regimen. A central question raised by this study is whether clinicians should attempt to maximize the dose of each medication class in a stepwise, hierarchical fashion versus maximizing the total number of evidence-based therapies for each patient.
There was also no ability to account for the titration of medications already prescribed on admission, and some patients may have had substantial augmentation of their medical regimen without starting new drugs.
The increasing complexity of medical regimens for HF poses substantial logistical and financial challenges to patients and threatens to erode compliance.
Given the burden of new medications required to comply with performance measures like GWTG-HF and the attendant logistical, financial, and safety concerns for patients, we must critically assess whether there is evidence to support continued focus on an inpatient strategy alone.
S. I. Chaudhry, J. A. Mattera, J. P. Curtis et al., New England Journal of Medicine, vol. 363, no. 24, pp. 2301–2309, 2010.
Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure
By monitoring symptoms that reflect a patient’s physiological struggle to remain euvolemic, telemonitoring holds promise in reducing hospital readmissions and significantly improves patient morbidity and mortality, as well as quality of life.