group assignment

Heart Failure and Cardiomyopathies

1410 JACC April 5, 2016

Volume 67, Issue 13

USING TECHNOLOGY TO REDUCE READMISSION RATES FOR CONGESTIVE HEART FAILURE IN HIGH RISK PATIENTS

Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m.

Session Title: Acute Heart Failure: From Door to Discharge and Back Again Abstract Category: 26. Heart Failure and Cardiomyopathies: Clinical Presentation Number: 1171-052

Authors: Lou Vadlamani, Kelley Anderson, Seema Kumar, Avera St. Lukes, Aberdeen, SD, USA Background: Congestive heart failure remains a major reason for readmissions for certain high risk patients. Some of these readmissions can be lowered with aggressive follow up and close monitoring of certain high risk patients. Unfortunately, given limited resources it is often challenging to provide the attention and follow-up needed to tackle this challenge. Methods: We selected patients with a history of 30 day readmissions within the last 6 months for CHF. At the time of discharge (3rd admission for CHF within 6 months), these patients were scheduled to see their primary cardiologist within one week; also, they were asked if they would be willing to receive a daily automated call asking 7 questions. Patients who agreed were enrolled in the study. These patients received daily calls which asked a series of questions. Based on their responses, they were categorized into high risk - those with an impending presentation to the emergency room within 24 hours; intermediate risk - those that had some clinical deterioration since discharge; and low risk- patients who were stable. The high risk patients were seen the next day; intermediate risk patients - had a telemedicine evaluation within 24 hours; low risk continues with daily phone calls. Patients were followed for 30 days. The “control group” was assigned to “usual care” as prescribed by the admitting cardiologist /b> Results: Over a 4 month period, out of 83 patients who met criteria, we enrolled 43 were randomized to receive the “aggressive” follow up and 40 to “usual care”. Of the 43 patients in the “aggressive” follow-up group, 2 (4.65%) were re-admitted within 30 days for CHF. In the “usual care” group of 40 patients, 7 (17.5%) were readmitted for CHF Conclusions: In our small study, using technology to identify and assess “at risk” patients, we were able to significantly reduce 30 day readmissions. While it would be ideal to have every patient seen frequently in the office, it is inherently infeasible given the limited resources at our disposal. However, our protocol could possibly identify and assess patients and preempt a hospital admission, while using limited resources effectively and efficiently.