Health education interventions to reduce chronic heart failure readmissions

¶ … Health Education on Re-Hospitalization of Patients With Chronic Heart Failure

The heart failure is one of the top health problems in the United States leading to high rate of morbidity and mortality among people aged 60 years and above. The complicated health problems of heart failure makes the readmission rates to increase within 30 days of patients' discharges. In essence, increase of readmission rate has been associated with high health healthcare costs in the United States. Based on the correlation between high rate of readmission and its associated high costs, this paper argues health education is an effective tool that can reduce the rate of readmission. Techniques to carry out the health education include home visit, telephone calls, and tele-monitoring to enhance a greater understanding of patients on the strategy to carry out an effective self-care management.

Introduction

In the contemporary health environment, the HF (heart failure) is one of the major public health problems, and a top cause of high healthcare costs and hospitalization in the United States. Moreover, the heart failure is the top cause of hospitalization among people above 65 years of age. Annually, more than 1 million people are being hospitalized accounting for more than $17 billion Medicare expenses. Despite the high expenses attributed to heart failure treatment, however, nearly 25% of patients suffering from heart failure are being re-hospitalized within 30 days. In 2007, the readmission rates of heart failure are the high priority within the clinical environment because heart failure is costly, common, however, often preventable. Typically, approximately 12.5% of re-hospitalization of heart failure is preventable. Since a decline of re-hospitalization will significantly reduce costs as well as improving the quality of healthcare delivery, the "the U.S. Center for Medicare & Medicaid Services" (Desai, & Stevenson, 2012 p 501) has started levying financial penalties on hospitals that record highest readmission rates within 30 days after the hospital discharge.

As a nursing professional, my experience revealed that patients above 60 years suffering from congestive heart failure were being re-hospitalized less than 30 days of admission. Thus, high rates of readmission makes this paper to develop strategies to reduce rates of re-hospitalization among patients with heart failures.

Clinical Questions

Is health education an effective intervention to reduce the readmission rates within 30 days for patients > 60 years of age suffering from CHF (chronic heart failure)?

Background Information

The heath failure is the major health problem in the United States, and more than 5.1 million people are suffering from heart failure. In 2010, approximately 7 million Americans are suffering from heart failure, and by 2030, additional three million people are likely to suffer from chronic heart failure. Typically, heart failure happens when heart is unable to pump sufficient oxygen and blood to support other organs of the body. Moreover, heart failure contributes to one out 9 deaths in the United States. Additionally, the costs of heart failure are approximately $32 Billion annually. The total costs include the costs of medications, and health services to treat heart failure and missed days works. (CDC, 2014).

Gheorghiade, Vaduganathan, Gregg (2013) contribute to the argument by pointing out that heart failure is associated with mortality, morbidity and increase in healthcare expenditures. Nearly one million hospitalization occur annually, and $37.2 billion is spent on the treatment of heart failure in the United States. Thus, increase of heart failure has made the re-hospitalization to increase annually.

Gheorghiade, Vaduganathan, Gregg (2013) argue that 27% of hospitalization occurs among Medicare beneficiaries within 30 days. However, 37% of the patients readmitted are people suffering chronic heart failure. More importantly, 24% of patients with heart failure are re-hospitalized within 30 days of their discharge. Factors that lead to re-hospitalization include cardiac factors, which include atrial fibrillation, myocardial ischemia as well as uncontrolled hypertension. Moreover, patient-related factors that lead to re-hospitalization include medication non-adherence, alcohol abuse, drug abuse and dietary indiscretion. The system-related factors such as inadequate medications, inadequate follow-up care, "limited access to low-sodium foods and poor transitions of care." (Gheorghiade, Vaduganathan, Gregg 2013 p 340) are also the causes of re-hospitalization.

A report carried out by the AHRQ (2014) reveals that a discharge from an hospitalization is followed by 24% of cases readmission with 30 days. The recurrent heart failure as well as related cardiovascular disease account for approximately 50% of readmission, whereby other comorbid health conditions account for the rest of 50% . Despite the identification of major cause of readmission, it is still challenging to assemble risk model associated to readmission. However, several physiological indices can lead to high rate of heart failure, however, there is still correlation that cases of cardiac troponins and natriuretic peptides are associated with the rate of heart failure. Typically, the readmission rates of heart failure are also higher when socioeconomic and psychosocial factors limit patients to comply or adhere with medications. Resources limitations of health centers are also associated to high rate of re-hospitalization of patients with heart failure in the United States. Moreover, there is higher readmission rates among low income patients than patients with higher income. A local practice of hospital also contributes to high rate of readmission. For example, hospitals recording high rate of patients with chronic heart failure tend to record higher rates of readmission.

"Reducing hospital readmission rates is a national priority. Approximately 20% of Medicare beneficiaries are readmitted within 30 days of discharge, and these readmissions have been estimated to cost the American public >$15 billion per year" ( Bradley, Curry, Horwitz, et al. 2013 p 444).

Literature Search Strategy

The study searches the MEDLINE Cochrane Library to collect data related to rates of heart failure and its complications in the Unitec States. Moreover, the study searches the CINAHL ("Cumulative Index to Nursing and Allied Health Literature)" (AHRQ 2014, p 4).between 2007 and 2008. The study also searches the electronic database of cohort studies between 1990 and 2014. The study manually searches the reference lists, background articles to identify relevant citations. Additionally, the researcher searches the relevant citations that the study might have missed. More importantly, the study searches for unpublished studies from ClinicalTrials.gov. The keywords used to search the literatures include readmission rates, re-hospitalization, heart failure, quality improvement, patient readmission, health promotion and health education. The review also focuses on correlation between mortality and readmission rates. The paper includes the following essential contents for the literature searches: cause of readmission, cause of heart failure and influence of health education on readmission rate. The Table 1 reveals the summary of the literature search in Table 1.

Table 1

Total number of record after the search and after 2564 duplicates have been removed:

MEDLINE 1650

CINAHL 134

Cochrane Library 455

Hand searches: 139

Conclusion

The studies carries out a literature search to reveal the rate of readmission of patients with chronic heart failure. Outcomes of the search reveal that rate of readmission increases within 30 days after patients have been discharge. The study suggests that health education is an effective tool to reduce the readmission rates.

Reference

AHRQ (2014).Transitional Care Interventions To Prevent Readmissions for People With Heart Failure. Comparative Effectiveness Review. Number 133.

Bradley, E.H. Curry, L. Horwitz, L.I. et al. (2013). Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure. Circulation: Cardiovascular Quality and Outcomes. 6: 444-450

CDC (2014). Heart Failure Fact Sheet. Center for Heart Disease Control and Prevention.

Desai, A.S. & Stevenson, L.W. (2012). Re-hospitalization for Heart Failure Predict or Prevent? Circulation. 126: 501-506.

Gheorghiade, M. Vaduganathan, M. Gregg C. Fonarow, G.C. (2013). Rehospitalization for Heart Failure Problems and Perspectives. J Am Coll Cardiol. 61(4):391-403.

Resnik, D.B. (2007). Responsibility for Health: Personal, Social, and Environmental. J Med Ethics. 33(8): 444-445.