SESSION TYPE: Heart Failure
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Congestive heart failure (CHF) is the largest health care expenditure in the United States. Patients with CHF have a high 30-day hospital re-admission rate often due to both dietary and pharmacological non-compliance. The objective of this study is to assess if trained volunteers can be used to increase patients’ compliance with the treatment of CHF, thereby, reducing their 30-day re-admission rate.
METHODS: A total of 137 patients who were hospitalized with acute exacerbation of CHF were randomly assigned to either an interventional arm (Arm A) who received dietary and pharmacological education by a trained volunteer, and a follow up phone call within 48 hrs of discharge, followed by a weekly phone call for one month; or to a control arm (Arm B) who received routine hospital care. The primary outcomes were 30-day re-admission rate for CHF and worsening New York Heart Association (NYHA) classification. Secondary outcome was a composite of the primary outcomes and mortality.
RESULTS: The 30-day re-admission rate in Arm A was 7% compared to 19% in Arm B with a relative risk reduction of 63% and an absolute risk reduction of 12% (p < 0.05). Worsening NYHA class on follow-up was 8 % for patients in Arm A vs. 23% for Arm B with a relative risk reduction of 64% and an absolute risk reduction of 15% (p< 0.05). The composite outcome of 30-day re-admission, worsening NYHA class, and death, was 21% for Arm A and 49% for Arm B with a relative risk reduction of 57% (p= 0.001).
CONCLUSIONS: The use of trained volunteer staff to educate patients hospitalized with congestive heart failure about their disease and to reinforce both pharmacologic and non-pharmacologic compliance can improve both 30-day re-hospitalization and morbidity.
CLINICAL IMPLICATIONS: Reducing hospital re-admissions will improve the quality of care and the hospitals will be able to cut down their expenses.
DISCLOSURE: The following authors have nothing to disclose: Muhammad Ashraf, Leela Lella, Geetha Bhumireddy, Mimi Makovitzky, Mikail Kamal, Raqib Cesar, Jiaxin Huang, Elizabeth Cusick, Jane Norenberg, Terrence Sacchi, Sorin Brener, John Heitner
No Product/Research Disclosure InformationNew York Methodist Hospital, Brooklyn, NY