Heart failure that develops or worsens during a hospital stay can affect outcomes, costs, and readmissions, so hospitals are advised to identify patients at risk for secondary heart failure.

Heart failure is the leading cause of hospital admissions and readmissions in patients older than 65 years, and is a leading cause of death among hospitalized patients, notes Vlad Gheorghiu, MSN, NP, AGACNP-BC, PCCN-CMC, a graduate student in the Adult-Gerontology Acute Care Nurse Practitioner Program at the School of Nursing at California State University (CSU), Los Angeles. However, patients who are admitted for a different reason may develop secondary heart failure while they’re in the hospital, complicating their recovery.

Gheorghiu’s recent research explores possible strategies that nurses and clinicians can use to identify secondary heart failure in hospitalized patients and implement early measures to prevent progression to acute decompensated heart failure. He worked with program coordinator Thomas W. Barkley, Jr., PhD, ACNP-BC, director of nurse practitioner programs at CSU, for the research. (The article is available online for a fee at: http://bit.ly/2vvtmii.)

Addressing this risk begins at admission but should continue after discharge, he says. Patients can quickly progress to acute decompensated heart failure if early signs and symptoms of heart failure are not identified in a timely manner.

Early discovery and intervention are important, but should be reinforced along the continuum of care, including after discharge, Gheorghiu says. Reimbursement pressures related to readmissions and outcomes should be another motivation for hospitals to address this risk, he says.

“The restrictions they’re putting on payment and reimbursement are based on outcomes, so it is very important for hospitals and healthcare systems to take measures that prevent complications or lead to longer hospital stays,” he says. “It’s important to come up with a system that engages patients and providers. The hospitals that have addressed this effectively engaged a wide range of people, including dieticians, pharmacists, case managers — all the people who can provide the necessary elements to make sure the patient is safely discharged home.”

Heart failure management should include stratifying risk based on factors such as age, heart rate, blood pressure, diabetes, and existing cardiovascular conditions, he says. An effective program also will focus on recognizing early signs and symptoms, identifying differences between heart failure and conditions with similar symptoms, and correlating assessment results with laboratory data.

Gheorghiu also recommends that a patient’s plan of care incorporate guideline-directed medical therapy, management of comorbid conditions and precipitating risk factors, health promotion, and self-care education. At the organizational level, hospital-established protocols should identify and assess patients with potential and existing heart failure, and comprehensive education programs for nurses and other clinicians also may improve outcomes for high-risk patients, he says.

At the hospital where he previously worked, Gheorghiu says, clinicians routinely identified patients with active heart failure and those at risk for heart failure, regardless of their cause for admission.

“Based on that list, we would implement a bundle or protocol of things we had to do with that patient each day or that had to be done prior to that patient’s discharge,” he says. “For example, we would work with the dietician to provide an appropriate diet when the patient went home, and we would work with the pharmacist to provide education on heart failure medication and how take them. We reinforced symptoms to watch out for at home that could indicate heart failure is worsening, and how to keep track of their weight daily, all to catch symptoms early and keep patients from decompensating.”

Gheorghiu says his research found few hospitals utilizing such a protocol specifically to identify and manage patients with secondary heart failure.