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Rehospitalization for heart failure: problems and perspectives.

Abstract

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 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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  • Authors+Show Affiliations

    ,

    Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: m-gheorghiade@northwestern.edu.

    ,

    Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

    ,

    Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.

    Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine, Chicago, Illinois.

    Source

    MeSH

    Aged
    Aged, 80 and over
    Comorbidity
    Cost of Illness
    Disease Management
    Evidence-Based Practice
    Female
    Heart Failure
    Humans
    Length of Stay
    Male
    Middle Aged
    Outcome and Process Assessment (Health Care)
    Patient Discharge
    Patient Readmission
    Prognosis
    Risk Assessment
    Severity of Illness Index
    Stroke Volume
    Survival Rate
    United States

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    23219302

    Citation

    Gheorghiade, Mihai, et al. "Rehospitalization for Heart Failure: Problems and Perspectives." Journal of the American College of Cardiology, vol. 61, no. 4, 2013, pp. 391-403.
    Gheorghiade M, Vaduganathan M, Fonarow GC, et al. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61(4):391-403.
    Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization for heart failure: problems and perspectives. Journal of the American College of Cardiology, 61(4), pp. 391-403. doi:10.1016/j.jacc.2012.09.038.
    Gheorghiade M, et al. Rehospitalization for Heart Failure: Problems and Perspectives. J Am Coll Cardiol. 2013 Jan 29;61(4):391-403. PubMed PMID: 23219302.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rehospitalization for heart failure: problems and perspectives. AU - Gheorghiade,Mihai, AU - Vaduganathan,Muthiah, AU - Fonarow,Gregg C, AU - Bonow,Robert O, Y1 - 2012/12/05/ PY - 2012/01/29/received PY - 2012/08/27/revised PY - 2012/09/11/accepted PY - 2012/12/11/entrez PY - 2012/12/12/pubmed PY - 2013/4/4/medline SP - 391 EP - 403 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 61 IS - 4 N2 - 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 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23219302/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(12)05296-5 DB - PRIME DP - Unbound Medicine ER -