CHICAGO – Two initiatives that could drastically lower the likelihood of heart failure patient readmissions were presented in March at the American College of Cardiology’s (ACC) 61st Annual Scientific Session.
A one-page, 27-question heart failure checklist developed by Abhijeet Basoor, MD, and a heart failure toolkit created by ACC’s Best Practice and Quality Improvement Subcommittee, can both be used during a patient’s hospital stay and discharge.
With heart failure costs reaching $29 billion each year in treatment and carrying a relatively high 30-day readmission rate at 20 percent, hospitals are looking to resources like the heart failure checklist and toolkit to manage costs, care and readmissions.
According to Richard Kovacs, fellow of the ACC, clinical director of the Krannert Institute of Cardiology and a contributor to the heart failure toolkit, it can cost a hospital between $5,000 and $10,000 for one heart failure patient readmission. Under the Affordable Care Act, hospitals may not be reimbursed for readmissions occurring within a 30-day period.
ACC’s heart failure toolkit strives to include all best practices and solutions related to heart failure, said Kovacs.
“We developed tools to fill in the gaps of what we were already providing for heart failure care. We also developed tools for the patients themselves, which includes side effects and medication doses,” he said.
Basoor, who practices internal medicine and cardiology at St. Joseph Mercy Oakland Hospital in Pontiac, Mich., said that everything on the checklist he created is derived from and reinforces evidence-based practices for managing heart failure and lowering the likelihood of another cardiac event.
The checklist was developed and used after approval from the hospital’s cardiovascular quality integration board. It is divided into three parts: medications and their appropriate dose modification; counseling and monitoring intervention; and follow-up instructions.
Clinicians who used Basoor’s checklist while a patient with heart failure was hospitalized and at discharge were able to cut the percentage of patients who were readmitted to the hospital within one month of a cardiac event from 20 percent to 2 percent. The readmission rate continued to be lower six months after discharge. If broadly adopted, the checklist could translate into billions of Medicare dollars saved each year.
“Patients can bring the checklist to follow-up appointments if their doctor doesn’t have a copy. The checklist provides simple reminders to instruct patients about things like diet, weight, blood pressure monitoring and appropriate drug dose up-titration,” said Basoor. “Nursing staff and physicians can use the checklist at the time of admission so everyone is educated and knows the procedures from the beginning, plus they can help patients better understand what is going on.”
“Our goal is that once patients know what’s going on, they’ll have the tools to do their part and clinicians will have tools to do their parts,” said Kim Birtcher, clinical associate professor at the University Houston College of Pharmacy and contributor to ACC’s toolkit. “It also will increase a patient’s quality of life – no longer going in and out of the hospital all of the time. Hopefully we can make this toolkit widely available for others really soon.”