Rehospitalization for Heart Failure

Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: .
Journal of the American College of Cardiology (Impact Factor: 16.5). 11/2012; 61(4). DOI: 10.1016/j.jacc.2012.09.038
Source: PubMed


With a prevalence of 5.8 million in the United States alone, heart failure (HF) is associated with high morbidity, mortality, and healthcare expenditures. Close to 1 million hospitalizations for heart failure (HHF) occur annually, accounting for over 6.5 million hospital days and a substantial portion of the estimated 37.2 billion dollars that is spent each year on HF in the United States. Although some progress has been made in reducing mortality in patients hospitalized with HF, rates of rehospitalization continue to rise, and approach 30% within 60 to 90 days of discharge. Approximately half of HHF patients have preserved or relatively preserved ejection fraction (EF). Their post-discharge event rate is similar to those with reduced EF. HF readmission is increasingly being used as a quality metric, a basis for hospital reimbursement, and an outcome measure in HF clinical trials. In order to effectively prevent HF readmissions and improve overall outcomes, it is important to have a complete and longitudinal characterization of HHF patients. This paper highlights management strategies that when properly implemented may help reduce HF rehospitalizations and include adopting a mechanistic approach to cardiac abnormalities, treating noncardiac comorbidities, increasing utilization of evidence-based therapies, and improving care transitions, monitoring, and disease management.

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Available from: Gregg C. Fonarow, Apr 22, 2014
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    • "There is no denying the significant advances in treatment strategies for HF, including drug and device therapy, cardiac transplantation, and mechanical circulatory support. However, despite these, the prognosis has not improved in worsening chronic HF, de novo HF and advanced or end-stage HF, which continue to have high mortality and re-admission rates [2–6]. Whilst the basic biology has pointed to a host of potential therapeutic targets with successful phase 2 trials, few of these have translated to phase 3 trial successes. "
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    ABSTRACT: Heart failure (HF) is a major and growing cause of morbidity and mortality. Despite initial successes, there have been few recent therapeutic advances. A better understanding of HF pathophysiology is needed with renewed focus on the myocardium itself. A new imaging technique is now available that holds promise. T1 mapping is a cardiovascular magnetic resonance (CMR) technique for non-invasive myocardial tissue characterization. T1 alters with disease. Pre-contrast (native) T1 changes with a number of processes such as fibrosis, edema and infiltrations. If a post contrast scan is also done, the extracellular volume fraction (ECV) can be measured, a direct measure of the interstitium and its reciprocal, the cell volume. This dichotomy is fundamental - and now measurable promising more targeted therapy and new insights into disease biology.
    Current Cardiovascular Imaging Reports 09/2014; 7(9):9287. DOI:10.1007/s12410-014-9287-8
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    • "Heart failure is a prevalent and costly condition, affecting some 5.1 million people in the U.S. [1]. It accounts for more than 1 million hospitalizations and approximately 2.8 million physician office, emergency department (ED), and hospital outpatient visits each year, at an estimated cost exceeding $32 billion [2]. "
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    ABSTRACT: Heart failure is a prevalent health problem associated with costly hospital readmissions. Transitional care programs have been shown to reduce readmissions but are costly to implement. Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed. The objective of this randomized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure. A multi-center, randomized controlled trial is being conducted at six academic health systems in California. A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure. Patients in the intervention group will receive intensive patient education using the 'teach-back' method and receive instruction in using the telemonitoring equipment. Following hospital discharge, they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a centralized call center. The nurses also will call patients and patients' physicians in response to alerts generated by the telemonitoring system, based on predetermined parameters. The primary outcome is readmission for any cause within 180 days. Secondary outcomes include 30-day readmission, mortality, hospital days, emergency department (ED) visits, hospital cost, and health-related quality of life. BEAT-HF is one of the largest randomized controlled trials of telemonitoring in patients with heart failure, and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring. The study population also includes patients with a wide range of demographic and socioeconomic characteristics. Once completed, the study will be a rich resource of information on how best to use remote technology in the care management of patients with chronic heart failure.Trial registration: # NCT01360203.
    Trials 04/2014; 15(1):124. DOI:10.1186/1745-6215-15-124 · 1.73 Impact Factor
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    • "Indeed, mortality may represent a competing risk factor for rehospitalization [98, 99]. In addition, short-term rehospitalizations might also be related to non-modifiable factors, such as social support, geographic location, and socioeconomics, so that there is a discrepancy between early readmissions and post-discharge mortality [100]. On the other hand, it must be remarked that the RELAX-AHF trial was neither designed nor powered to assess mortality as an endpoint. "
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    ABSTRACT: Acute heart failure (AHF) is characterized by high morbidity and mortality and high costs. Although the treatment of AHF has not changed substantially in recent decades, it is becoming clear that treatment strategies for AHF need to address both the immediate hemodynamic abnormalities giving rise to congestion as well as prevent organ damage that can influence long-term prognosis. Serelaxin, the recombinant form of human relaxin-2, a naturally occurring peptide hormone, has been found to significantly improve symptoms and signs of AHF, prevent in-hospital worsening heart failure, as well as significantly improve 180-day cardiovascular and all-cause mortality after a 48-h infusion commenced within 16 h of presentation (RELAX-AHF study). Available data suggest that the clinical benefits may be attributable to a potential combination of multiple actions of serelaxin, including improving systemic, cardiac, and renal hemodynamics, and protecting cells and organs from damage via anti-inflammatory, anti-cell death, anti-fibrotic, anti-hypertrophic, and pro-angiogenic effects. This manuscript describes the short- and long-term effects of serelaxin in AHF patients, analyzing how these effects can be explained by taking into account the range of hemodynamic and non-hemodynamic actions of serelaxin. In addition, this paper also addresses several aspects related to the role of serelaxin in the therapy of AHF that remain to be clarified and warrant further investigation.
    American Journal of Cardiovascular Drugs 03/2014; 14(4). DOI:10.1007/s40256-014-0069-0 · 2.42 Impact Factor
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