What Are the Factors Behind Readmission Rates of HF Patients?

The majority of studies examining readmission rates in heart failure (HF) patients point to a common trend: patients who are nonadherent to medications and diet recommendations are much more likely to be readmitted. Poor self-care and “social factors” are often identified as reasons for nonadherence—most research, however, fails to dig deeper, according to Debra K. Moser, RN, University of Kentucky, College of Nursing, Lexington, KY.

At a presentation Wednesday during the HFSA 14th Annual Scientific Sessions entitled, “Heart Failure Recommendations: The 2010 Challenge,” Moser explored the environmental and social factors behind readmissions for HF patients, using as a case study the coal mining region of Kentucky and neighboring states.

“Some studies have suggested lower socioeconomic status as a possible factor, but these precipitants are difficult to measure,” said Moyer. The best thing to do? Talk to patients and their family members, asking questions like specific foods they eat, where they do their grocery shopping, is there fresh produce available, are they able to drive or walk to the stores, do they have sufficient storage for frozen produce—“these are all important questions,” she noted.

Social support has also shown to be a critical factor in adherence, according to Moser, who says that advice and pressure from loved ones can lead to adoption of healthy behaviors, which in turn can prevent rehospitalization. On the other hand, lower perceived social support is associated with increased rates of morbidity and mortality, she noted.

Moser urged clinicians to make sure patients who live alone or don’t have close family have access to a support system through a hospital or other healthcare organization.

In another presentation, Barry M. Massie, MD, University of California, San Francisco, looked at the scope of the problem; heart failure, he said, leads to 1.1 million hospital admissions every year, and contributes to another 2.3 million admissions.

As the incidence of HF increases with age, he said he believes the problem will only worsen in the future. While mortality rates in HF patients have decreased, hospitalization rates have gone the other way, increasing significantly from 1974 to 2004.

Although there is a great deal of debate over what criteria should be considered most important in determining readmission rates, and whether readmission itself is always a negative event, what is known, according to Massie, are the approaches that have proven successful in prevention hospitalization: multi-disciplinary team interventions, home care, nurse case management, monitoring through telephone calls, home visits, heart failure clinics, and natriuretic peptide guided therapy.

Finally, David J. Whellen, MD, Jefferson Medical College, Philadelphia, PA, explored disparities in readmission rates, adding the type and location of a facility can impact this statistic, as well as the type of physician attending to the patient.

From the patient’s perspective, factors such as race, insurance type, and the presence of comorbidities can certainly impact rate of readmission, he added, citing a study published in the Journal of the American College of Cardiology.

“Hospitals may play a significant role in readmission rates, in terms of differences in quality of care,” he said. “It’s something that all facilities need to address.”