Strategies to Reduce Heart Failure Hospitalizations and Readmissions: How Low Can We Go?

Abstract

It is estimated that more than one million heart failure hospitalizations occur each year. Systolic heart failure and heart failure with preserved ejection fraction contribute equally to heart failure hospitalizations. Heart failure readmission rates continue to be about 25%. Strategies to reduce heart failure readmission are key to reducing hospitalization rates. The strategies to reduce heart failure hospitalization are as follows: (1) During hospitalization, diuresis to the euvolemic state is essential. Fifty percent of discharged heart failure patients have minimal weight loss during the hospitalization, representing minimal diuresis, but still fluid overload. (2) During hospitalization, interrogate the defibrillator or biventricular pacemaker (if applicable) to ensure that there is no right ventricular pacing and there is appropriate biventricular pacing. Interrogation of devices can identify arrhythmia or suboptimal biventricular pacing, which can contribute to decompensation. (3) Before discharge, identify the reason for decompensation, such as atrial fibrillation, infection, pulmonary embolism, or noncompliance. (4) Before discharge a multidisciplinary team is needed to educate the patient on diet, medications, fluid weight surveillance, and exercise. (5) A postdischarge visit should occur within 10 days and with emphasis on uptitration of neurohormonal blockers and continued congestion management. Such interventions conducted by a multidisciplinary team have the potential to reduce heart failure hospitalization rates.