PURPOSE: The 6-month readmission rate for congestive heart failure (CHF) is as high as 50%. Studies have shown that upward titration of ACE inhibitor (ACE I) or angiotensin receptor blocker (ARB) and beta-blockers after discharge resulted in reduced hospital re-admission rates, improved functional capacity and quality of life. Despite compelling scientific evidence and readily accessible national guidelines, life-prolonging agents remain underused. We present our community based randomized controlled trial to show the effect of quality improvement discharge tool in CHF.
METHODS: CHF discharge checklist was developed and randomly used in patients admitted with primary diagnoses of CHF from August 2008 to October 2009. Checklist included documentation regarding medications and dose titration, relevant counseling and follow-up instructions. During the same time period control group comprising equal number of men and women admitted for CHF was randomly selected.
RESULTS: CHF discharge checklist and control groups comprised 48 patients each, with women being 44% (21 of 48). Baseline characteristics of the two study groups including comorbidities were comparable. Rate of dose up titration for beta-blockers and ACE I/ARB was significantly more common in checklist cohort (21 of 48 Vs 4 of 48, p = 0.002). Higher proportions of patients were not on ACE I/ARB in control group compared to checklist group (25 of 48 Vs 8 of 48, p = 0.01). Total number of readmissions within 6 months of discharge was less in the checklist group with p value reaching almost statistical significance (29 of 48 Vs 15 of 48, p = 0.08).
CONCLUSIONS: The use of heart failure discharge checklist leads to improved rate of drug up titration with more proportion of patients being on the recommended medications. There was also a trend towards decreased readmissions.
CLINICAL IMPLICATIONS: A simple inexpensive discharge checklist for CHF leads to improved rate of optimization of medications and thus providing better quality of care. The trend towards decreased readmissions can lead to significant reduction in the burden on our health care.
DISCLOSURE: The following authors have nothing to disclose: Abhijeet Basoor, Nitin Doshi, John Cotant, Mina Todorov, Tarek Saleh, Kiritkumar Patel, Nishit Choksi, Michele DeGregorio, Abdul Halabi
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