ABSTRACT
A retrospective cohort study was performed of the Hospital-to-Home (H2H) program, a rapid clinic follow-up program for patients with recent heart failure (HF) admissions at the University of Virginia Health System. There were 6761 hospitalizations among 4685 patients (age 67.5 ± 14.2 years, 43.9% female), and 759 had H2H follow-up. Thirty day mortality after the initial HF hospitalization was lower in H2H patients (1.84% vs 3.13%; P = .049), and this difference remained significant after adjustment in a multivariable logistic regression model (odds ratio = 0.56 [95% CI = 0.31-099]; P = .046). There also was a 24% reduction in readmission days within the first 30 days after the index admission ( P < .0001), and readmission cost savings were found to be greater than the costs of staffing the H2H clinic. In summary, the H2H program is cost-effective, with significant improvements in survival, readmission days, and readmission costs over 30 days.
Subject(s)
Heart Failure/economics , Heart Failure/therapy , Patient Discharge/economics , Patient Readmission/economics , Aged , Female , Follow-Up Studies , Heart Failure/epidemiology , Humans , Male , Middle Aged , Patient Discharge/statistics & numerical data , Patient Readmission/statistics & numerical data , Retrospective Studies , Risk FactorsSubject(s)
Myocardial Infarction/therapy , Near Miss, Healthcare , Patient Discharge , Patient Readmission , Health Status , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Patient Care Team , Program Development , Program Evaluation , Quality Improvement , Quality Indicators, Health Care , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: While advancements in ventricular assist device (VAD) therapy have improved survival and quality of life for select patients with advanced heart failure (HF), variations in provider knowledge and opinions may ultimately serve as barriers to therapy. METHODS AND RESULTS: A 12-item survey assessing experience, knowledge, and perspectives of VAD therapy was sent to 106 practicing cardiologists at three neighboring institutions. We received 34 responses for a total response rate of 32.1%. The majority of respondents elected to refer patients with refractory disease for VAD therapy, while only 29.4% elected to refer when standard medical therapy is withdrawn due to hypotension. CONCLUSIONS: While providers are well-informed on the fundamentals of advanced therapy, identifying patients with advanced HF who may benefit from referral remains an educational challenge. An automated referral program that identifies patients with advanced HF based on validated clinical parameters could increase appropriately timed referrals to HF specialists to further improve survival and quality of life outcomes with advanced therapy.
