Factors Affecting Heart Failure Readmission Rates in VA Patients

Conclusions

In general, earlier and more frequent readmissions were more common in patients who were converted to oral diuretic therapy for < 24 hours before discharge and were not discharged on an ACE-I/ARB and a b-blocker when appropriate. Additionally, most of the readmitted patients had no follow-up scheduled at discharge, were nonadherent with medications and follow-up appointments, and were not enrolled in the CHF and/or CHF-PharmD clinic. The majority of patients with systolic HF were not at target doses of either the ACE-I/ARB or the ß-blocker when readmitted. Overall, JBVAMC had a low percentage of patients readmitted for HF within 30 days, but there is still room for improvement in reducing HF readmissions.

At the time of discharge, all JBVAMC patients receive printed instructions and recommendations for their care after hospitalization. The patient handout includes the most current medications, diet/weight/medication instructions, and actual or suggested dates for follow-up appointments and/or tests. It may enhance awareness regarding dietician services to patients if the current discharge instruction template can be modified to provide information regarding the outpatient dietitian class. This could include date, time, and location of classes as well as dietician contact information. (See Appendixes 1 and 2.)

When these recommendations have been implemented, further studies will be warranted to assess the impact of the interventions. 

Acknowledgments
The authors thank Ms. Yvette Bloodson for her assistance in generating the initial patient list.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.