Category: Federal Forum Posters
Purpose: Heart failure hospital readmission rates are extremely high with approximately one quarter of patients readmitted 30 days after discharge. The first 30 to 90 days following hospital admission for heart failure exacerbation are the most crucial in preventing heart failure readmissions. In recent studies, pharmacist intervention during hospital admission and pharmacist lead post-admission follow-up have shown reduction in readmission rates and improve therapy adherence in patients with heart failure. The primary objective of this project is to investigate the effectiveness of pharmacist led interventions, in the form of discharge education and post-admission follow-up, on reducing heart failure hospital readmission rates.
Methods: The project will be conducted from October 2018 and will continue through March 2019. The patient population will be those admitted for heart failure exacerbation at the Cheyenne Veterans Affairs Medical Center with a current and/or previous diagnosis of reduced ejection fraction heart failure during the above time frame. The above study population will then be compared to all reduced ejection fraction heart failure patient admissions from October 2017 to March 2018, looking for reductions in heart failure hospitalization readmission rates post-pharmacist intervention. Prior to hospital discharge, the pharmacist will provide the appropriate patients with education on managing heart failure at home and will be given a home action plan individually tailored to their needs. Following hospital discharge, a chart review will be conducted by the pharmacy resident to assess each patient’s heart failure status and medication therapy. After patients’ charts are reviewed, recommendations will be submitted to pharmacotherapy pharmacists to be reviewed with select patients. Post admission follow-up visits with the pharmacotherapy clinic will be scheduled accordingly. Subsequent follow-up visits with the pharmacotherapy clinic will be conducted for patients needing further review and continual heart failure management.
Results: From October 2017 to March 2018, 67 patients with heart failure exacerbations were admitted to the Cheyenne VA Medical Center. Of these patients, 37 have heart failure with reduced ejection fraction. Since that time, 16 of these patients have passed away. The primary endpoint will be to compare the heart failure readmission rates between the two cohorts. Secondary endpoints that will be compared to the previous year will include 30, 60, and 90 day readmission rates, death rates, and change in the number of patients on guideline recommended medications. Statistical analysis comparing the rates of readmission post-pharmacist intervention between the two cohorts have yet to be determined.
Conclusion: Readmission rates for heart failure exacerbations within the Cheyenne Veterans Affairs Medical Center are high, especially within the first 30 days after initial hospitalization. Pharmacy led interventions may have an impact on reducing the rates of readmission due to uncontrolled heart failure with reduced ejection fraction.
Marcie Hunt– PGY1 Pharmacy Resident, Cheyenne VA Medical Center, Cheyenne, WY