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Factors reducing readmission

Prior Edition of the 'Redefining Heart Failure Blog

In the prior edition of the “Redefining Heart Failure” blog series, we explored the context of readmission statistics and their relevance for understanding the cause for admission and measures to prevent it.

If you would like to read it before this part 3 on the factor which increases readmission, you can do so here:

Pt1. https://acorai.com/2022/06/05/the-current-state-of-heart-failure/

Pt2. https://acorai.com/2022/07/03/factors-increasi…readmission-2022/

Factors that reduce rehospitalisation rates at discharge are most substantial when evaluating Post-discharge self-care and lifestyle factors. In general, self-care education is known to reduce hospital admissions for all condition types, and the effects of these interventions are also in post-discharge HF patient populations. 

It is often intuitive that patient education and follow-up care can reduce readmission rates. For the general population, it is known that many readmissions occur due to misidentified symptoms or an overly-concerned patient who may not have received sufficient education. Unwarranted hospitalisation is avoided with the proper instruction. Therefore, follow-up care and monitoring can keep patients confident in their experienced symptoms and make sure post-discharge care is appropriate. 

Almost inherently coupled with education and follow-up care provisions, they correlate to low-volume hospitals and hyper-specialised care environments. There is a dilemma regarding the management of heart failure patients. High-volume hospitals are associated with lower in-hospital mortality for HF patients, yet the readmission rates are lower for low-volume hospitals. This effect can be attributed to personalised care plans and resources available for education and follow-up programmes. However, an optimal setting would potentially exist in a Hub and spoke system that could dynamically permit access to high and low-volume hospital settings based on the current clinical needs of each HF patient. 

Summary of the prevailing themes impacting readmission

All these measures to Better manage patients and reduce hospital readmission rates are targeted to increase medication adherence. Pharmacological interventions (more than device interventions) have consistently demonstrated mortality and readmission benefits in patients who adhered to their medication regimen post-discharge. This shows that patients with high pharmacological adherence were readmitted at less than half of those who reported patchy or failed adherence.

Success in reducing readmission and activating successful strategies relies on the engagement of healthcare stakeholders, from Payors through to a sometimes desperate providers network. As part of successful readmission-reduction programs, hospitals can focus on teamwork between rehabilitation staff, hospital providers, and post-acute care nurses to maximise the efficiency of the active management of patients to ensure optimal medical therapy is reached. Additionally, by design, this creates designated liaisons between the patient, the hospital, and the patient’s care network post-discharge leading to a higher likelihood of adherence and continuous monitoring. 

A forward-looking view

There is a growing need for hospitals to manage patients with heart failure more effectively and efficiently with an ageing population. With additional pharmacological agents being more widely available, it has become possible to affect readmissions by embracing proactive and active monitoring strategies. These strategies are enabled by intracardiac pressure monitoring technologies in a pre-decompensated state. Instead, The alternative is the status quo of reactive and passive systems, relying on waiting for clinical signs of acute decompensation.

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