Reducing Heart Failure Readmissions: A Multidisciplinary Approach

Purpose: Heart failure (HF) is a chronic disease that progressively decreases patients’ ability of self-care, and is the most frequent reason for hospital readmissions.  Each year 27% of patients with HF on Medicare are readmitted within 30 days with an unplanned hospitalization costing $17.4 billion annually.  Medicare has recently implemented a financial penalty for hospitals based on their 30-day HF readmission rates.  Therefore, we sought to design a method for reducing these readmissions

Methods: Processes in three areas were piloted and subsequently implemented across the institution.  These steps included: early identification of HF patients upon admission; interdisciplinary education during the inpatient stay; interdisciplinary follow-up phone calls after discharge.   Patients with HF were targeted for focused education from nursing, pharmacy and nutrition. Pharmacists directed education to patients and families on heart failure medications: ACE inhibitors, ARBs, beta blockers, diuretics, digoxin and vasodilators.  Medication education focused on pharmacologic impact on disease pathophysiology, possible side effects, dosing, regimen adherence, drug interactions and special instructions.  The educational efforts were initiated in January 2011.  A retrospective analysis of readmissions in HF patients for 2010 was conducted, which represented the pre-education group.  A prospective analysis of readmissions in HF patients was conducted in 2011, which represented patients exposed to the new education program.

Results: There were 532 admissions for HF in 2010 (pre-education group) and 482 in 2011(with education group).  There were no major differences between the HF patients in each group.  The rate of all-cause readmission for these HF patients was significantly reduced after implementation of the multidisciplinary program from 28% in 2010 to 20% in 2011 (p=0.003).  The incidence of HF readmissions were also decreased (12% vs. 5%; p<0.001). 

Conclusion: A multidisciplinary team approach, with pharmacist involvement focused on medication education, was able to contribute to significant reductions in readmission in patients with HF.