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A Collaborative Initiative to Utilize Telehealth Medicine for Veterans With Congestive Heart Failure to Reduce Hospital Readmissions FREE TO VIEW

John Ulahannan, MBBS; Shoma Singh, MD; Pratik Dalal, MBBS; Dean Humphreys, NP; Joan Mitchell, MD; Changwan Ryu, MD
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SUNY Upstate Medical Univeristy, Syracuse, NY

Chest. 2013;144(4_MeetingAbstracts):535A. doi:10.1378/chest.1704869
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SESSION TITLE: Cost and Quality Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Our facility 30-day readmission rate among veterans with congestive heart failure (CHF) remains well above the national standard. As part of a collaborative initiative with our cardiology department, we utilize telehealth medicine with a nurse practitioner (NP) calling all of our veterans with CHF within 30 days of discharge. In our efforts to improve these services, our aim is to identify which veterans with CHF would most benefit; we hypothesized that veterans with diastolic HF would experience significant reductions in readmissions from telehealth medicine.

METHODS: We collected 30-day readmission data all on veterans enrolled in our clinic (telehealth cohort) and not enrolled in our clinic (standard cohort) from 2008-2012. We deemed successful enrollment into our clinic as anyone who received a phone from our NP within 30 days of discharge. We then placed each cohort into one of two groups, systolic HF or diastolic HF based on their measured EF. A patient would be placed in the diastolic HF group if their EF was greater than 55%. Within the systolic HF group, we compared the readmission rate of 74 clinic cohorts and 120 standard cohorts. Within the diastolic HF group, we compared the readmission rate of 50 clinic cohorts and 65 standard cohorts.

RESULTS: Among our veterans with systolic HF, the overall readmission rate between the clinic cohort (21%) and the standard cohort (27%) was not statistically significant (Fischer Exact Test p=0.20). Among our veterans with diastolic HF, the overall readmission rate between the clinic cohort (11%) and standard cohort (29%) was statistically significant (Fischer Exact Test p=0.0008).

CONCLUSIONS: We found that by enrolling our patients with diastolic HF in our telehealth clinic their rate of readmissions was significantly reduced. Patients with diastolic HF may be less aware of the importance of symptom and weight management since it stands to reason they would be not as limited functionally as those with systolic HF. It is possible then, that by educating them post-discharge they may avoid further hospital admissions.

CLINICAL IMPLICATIONS: Diastolic HF and/or HF with a preserved EF has been an entity which has not been entirely treated the same as systolic HF. Current studies show that diastolic HF should be managed differently when it comes to aggressiveness of diuretic management, RAAS and Beta blockade. However, our analysis does show a benefit when these patients are followed closely after hospital discharge.

DISCLOSURE: The following authors have nothing to disclose: John Ulahannan, Shoma Singh, Pratik Dalal, Dean Humphreys, Joan Mitchell, Changwan Ryu

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