Quality

Quality

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Heart Failure Readmission Within 30 days

Heart failure characterizes a medical condition that arises from a collection of illness processes distressing the myocardial function. Current studies have recommended that people with heart failure endure an extraordinary rate of hospitalization and readmission. It has resulted in significant increase in public health burden.

Demographic Factors

Age

In most studies, age does not appear as an independent predictor or cause of re-admission for patients with heart failure (Chin et al., 2016). However, few studies have identified that patients aged 18 to 64 years have slightly higher rates of chronic heart failure re-admission (Su e al., 2019).

Gender

Various studies have contracting results, for example, men were more associated with coronary heart failure re-admission, whereas, women with hypertension (Kim et al., 2018). However, there were no significant differences between age, and male and female demographics in heart failure readmission within 6 months and 30-day re-admission.

Socio-economic Factors

Low socioeconomic status was reported to be an important cause of heart failure re-admission. Socioeconomic status is connected with 3 foremost factors and determinants of health. It includes ecological exposure, health behaviors and health care (Oh, 2011). The people from low socioeconomic status have more comorbid health illness as compared to other people. The probable reasons are a greater level of anxiety, stress and depression and the inadequate resources to afford a healthy lifestyle (Chin et al., 2016).

Race

Population from rural areas, African Americans, and median domestic financial resources are more contributed towards heart failure re-admission within 30 days. It is more likely to be associated with the affordability of comprehensive treatment programs. Race, social support and health literacy level were observed to be directly linked with the higher rates of heart failure re-admission (Su et al., 2019). Black and Hispanic patients tend to have a higher proportion of cardiovascular diseases and heart failure re-admission within 30 days (Chin et al., 2016). The major reason identifies as diabetes and hypertension.

Social Support

Social support is also linked with higher rates of heart failure and re-admission. Social support, in terms of family support, community support, and hours spent with family and living status, is also included in social support (Chamberlain et al., 2018). People living alone have a higher proportion of heart failure with readmission (Chin et al., 2016). It showed a tendency that patients with cardiovascular disorders need additional support and contribution from the family for the recovery.

Health Literacy

Various studies have been conducted that show a higher proportion of deaths in patients having least or no education regarding their health conditions (Chin et al., 2016). Patients lacking information and understanding regarding their cardiovascular disorders are more associated with mortalities, however, the rate of re-admission appeared to be the same.

Clinical Factors

Biomarkers

Numerous biomarkers have been established to be valuable in the forecast of readmissions in patients with heart failure, counting B-type natriuretic peptide (BNP), N-terminal pro-B–type natriuretic peptide (NT-proBNP), cardiac troponin and galectin-3. High-sensitivity troponin has been observed to be an interpreter of 6-month death or hospitalization due to heart failure or kidney failure, but is not linked to re-admission (Su et al., 2019).

Nutritional Health

Undernutrition is common in patients with heart failure and is related to the amplified danger of readmission (Chin et al., 2016). The projected occurrence in patients with prolonged heart failure and those admitted with heart failure is 13% to 69% (Su et al., 2019). Studies have shown that nutrition, weight, albumin level, and cholesterol level are the indicators of the health status of people. Malnutrition and inadequate amount of nutrients can lead to serious complications for the patients with heart failure and it is also a prognosis of heart failure with re-admission.

Diabetes Mellitus

Diabetes mellitus was found to be linked significantly with a rate of 39% to 42% in patients with heart failure (Su et al., 2019). It was observed in studies that diabetes mellitus is the major cause of heart failure and is also linked with heart failure readmission (Pronovost & Vohr, 2010). Women have been found with 5% higher rates of 30-day readmission, particularly with diabetes mellitus.

Renal Insufficiency

It is observed in patients with heart failure that renal dysfunctional is another major contributor to 30-day readmission (Chin et al., 2016). It is directly linked with the pressure and volume overload in the body that leads to chronic kidney failure and altered metabolism. The overall ratio of 70% of the patients were observed with kidney dysfunction and heart failure within 30-day readmission (Su e al., 2019).

Strategies for Improvement

7 Days Follow-Up

Patients with heart failure need to visit a healthcare facility every 7 days to follow-up. Suitable advocacy and appropriate nursing care can help the patient recover faster and quicker. 7 days follow-up is for all patients particularly for those having associated disorders such as diabetes and hypertension. Women were observed with higher rates of hypertension and it is recommended to follow-up the blood pressure record of those patients, predominantly females.

Home Healthcare Services

Patients with heart failure need additional support and care. For this particular purpose, patients need to utilize home-based healthcare services. These facilities will enable the patient to recover faster as they will have a healthcare provider beside them (Wasfy et al., 2017). Home-based facilities would also be helpful in terms of nutritional guide, and disease-related knowledge would be delivered.

Readmission-Focused Prevention

This strategy involves a series of actions to be implemented at a healthcare facility and home. It includes services related to health education and promotion. Adequate information delivered to the patients and their relatives can significantly reduce heart failure 30-day readmissions (Chin et al., 2016). Preventive measures involve, health education related to diet, disease, physical activity and strengthening social support. Patients with appropriate information and understanding regarding their cardiovascular disorders can reduce heart failure readmission within 30 days.

Transitional Care and Support

Social support is directly linked with the greater rates of heart failures and re-admission. Social support in expressions of family support, community support, hours spent with family and living status can be improved significantly with little effort. People living alone can be engaged in healthy activities and it can significantly reduce the higher proportions of readmissions in healthcare facilities.

Patient-Centered Care

Special attention to the patient-focused care and support can improve anxiety and depression levels of patients. Health education and regular and timely checkup of an essential biomarker such as B-type natriuretic peptide (BNP), and cardiac troponin along with renal and liver function tests can improve the health status of patients.

Nutrition Guide

Adequate nutrition and weight management guidelines can progress in the quality of patients. Regular and proper follow-up of albumin level, vitamins, minerals, cholesterol, and blood pressure can predominantly decline the ratio of patients with heart failure readmission in 30 days. It will also lead to better health and improvement in disease status.

Additional Care for Cardiovascular Related Problems

It has been observed in studies that maintaining blood glucose levels and appropriate healthy physical exercise can decrease the upsurge level of readmissions. Diabetes mellitus was found to be linked meaningfully with a percentage of 39 to 42 in patients with heart failure (Su et al., 2019). Renal dysfunction is also linked with the pressure and volume overload in the body that leads to chronic kidney failure and altered metabolism. It is also preventable by maintaining the body's metabolism. Appropriate and prescribed food, adequate amount of water, and sufficient nutrients can result in noteworthy diminution in readmission rate.

Enabling and Healthy Environment

Health education, knowledge of the disease, post-discharge instructions, and powerful strategies for prevention, health advocacy and patient-centered care can result in the long-term sustainable health status of patients (Su e al., 2019). Supporting and helping communities, skilled professionals and governmental level insurance programs can significantly reduce the number of heart failure readmissions in 30 days.

References

Chamberlain, R. S., Sond, J., Mahendraraj, K., Lau, C. S., & Siracuse, B. L. (2018). Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale. International journal of general medicine, 11, 127.

Su, A., Al'Aref, S. J., Beecy, A. N., Min, J. K., & Karas, M. G. (2019, July). Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature. In Mayo Clinic Proceedings (Vol. 94, No. 7, pp. 1304-1320). Elsevier.

Vader, J. M., LaRue, S. J., Stevens, S. R., Mentz, R. J., DeVore, A. D., Lala, A., ... & Dávila-Román, V. G. (2016). Timing and causes of readmission after acute heart failure hospitalization—insights from the Heart Failure Network Trials. Journal of cardiac failure, 22(11), 875-883.

Oh, J. (2011). Proven Ways to Reduce Hospital Readmissions. Becker’s Hospital Review.

Kim, L. K., Yeo, I., Cheung, J. W., Swaminathan, R. V., Wong, S. C., Charitakis, K., ... & Singh, H. (2018). Thirty‐Day Readmission Rates, Timing, Causes, and Costs after ST‐Segment–Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010–2014. Journal of the American Heart Association, 7(18), e009863.

Chin, D. L., Bang, H., Manickam, R. N., & Romano, P. S. (2016). Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Affairs, 35(10), 1867-1875.

Wasfy, J. H., Zigler, C. M., Choirat, C., Wang, Y., Dominici, F., & Yeh, R. W. (2017). Readmission rates after passage of the hospital readmissions reduction program: a pre–post analysis. Annals of internal medicine, 166(5), 324-331.

Pronovost, P., & Vohr, E. (2010). Safe patients, smart hospitals: how one doctor's checklist can help us change health care from the inside out. Penguin.

Institute of Medicine (US). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Graham, R., & Mancher, M. (2011). Clinical practice guidelines we can trust (p. 266). Washington, DC: National Academies Press.