CHF program reduces admissions by 85%
CHF program reduces admissions by 85%
Program focuses on ACE inhibitor use
A three-year study of 214 heart failure patients accepted for heart transplantation at the University of California at Los Angeles (UCLA) Medical Center’s Ahmanson Cardiomyopathy Center revealed that the center reduced hospital readmissions by 85% during the first six months after referral and achieved an estimated savings of $9,800 per patient.
Gregg C. Fonarow, MD, director of the center and lead author of the study,1 attributes the program’s success to its comprehensive approach to the management of heart failure patients.
He notes that conventional management of such patients usually centers on an individual physician who must coordinate adjusting medications, stabilizing the patient, and providing education. "But given [physicians’] time constraints and often not complete experience with every condition, or detailed knowledge regarding diet, exercise, and monitoring of fluids, there’s just not enough time for a real emphasis on disease management."
Fonarow adds that under conventional management, when patients leave the hospital, they’re often seen by a different physician for follow-up and further adjustment of medications.
UCLA’s more comprehensive approach involves optimizing patients’ medication, combined with detailed education for patients and their families, as well as "close communication and contact with a multidisciplinary heart failure center that’s really focused on disease management and prevention," Fonarow says.
Such an approach takes into account not just patients’ medications and laboratory tests but their personal adjustment to their condition. By addressing individual educational and dietary needs and making home nursing and social support available, clinicians are better able to involve patients actively in their own care, Fonarow says. "We try to anticipate all of the potential needs in areas where, if therapy fails, a patient will end up back in the hospital."
Specifically, when patients begin the program, a heart failure nurse specialist sits down with them for at least 30 minutes to provide detailed instructions regarding nutrition. The nurse covers areas including how to read sodium instructions on product labels and gives patients a five-page sheet of acceptable and unacceptable foods. He or she discusses how patients can adapt their diet to fit within the center’s guidelines and how to choose foods when eating out. Patients also receive detailed information on exercise, how to monitor symptoms, and when to gradually advance their exercise regimen.
"Patients get constant reinforcement every time they’re seen back at the center," Fonarow says. "We review their weight chart with them and answer any questions they have about their diet."
He notes that having patients monitor their weight daily is a good way to make them realize that their efforts toward self-care can have short-term results. "If they ate too much salt one day, their weight would go up the next day, and it would give them immediate feedback that they had taken in too much. So it actively involves patients in their own management and lets them see that this isn’t a futile, irreversible disease."
Fonarow notes, however, that the most significant factor UCLA found in sharply reducing the need for rehospitalization was the increased use of ACE inhibitors. At the beginning of the program, ACE inhibitors were given to the 78% of patients not already taking them, and doses were increased for the 22% who were.
Another key factor has been the use of a flexible diuretic regimen, coupled with the daily monitoring of patients’ weight. "About 70% of heart failure hospitalizations are due to volume overload," Fonarow points out. "So this meticulous attention to the patient’s volume status and having them actively involved in monitoring was very important."
Fonarow says that the study’s results highlight the potentially dramatic effects a comprehensive disease management program can have on heart failure. "It shows that there can be a real impact, and I think there needs to be a close look at whether the care for high-risk heart failure patients would be better served in a heart failure center or heart failure program," he says.
[For more information about UCLA’s CHF program, contact Gregg C. Fonarow, MD, director of the Ahmanson Cardiomyopathy Center, UCLA Medical Center, Room 47-123, 10833 Leconte, Los Angeles, CA 90095. Telephone: (310) 825-8816.]
Reference:
1. Fonarow G, et al., Hospital readmission for heart failure. J Am Coll Cardiol 1997; 30:725-732.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.