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Published on February 12, 2018

A familiar hospital is key for heart failure patients

For people with heart failure, staying healthy enough to avoid being admitted to the hospital is the best way to manage this chronic and often debilitating condition. However, when an admission is needed, sticking with the same hospital may result in a shorter length of stay and a higher chance of survival, according to a new Canadian study.

The study, published earlier this year in the Journal of the American Heart Association, sought to understand the effects of patients being hospitalized at different hospitals for readmissions. In Canada, it is not uncommon for patients to be readmitted to a different hospital, especially in rural areas.

Researchers noted that while it is well-known that surgical patients have poorer outcomes when readmitted to another hospital, there is no literature on heart failure patients.

Of the 217,000 patients studied, 18 percent were readmitted within 30 days. Of all of the patients who returned, 17 percent went to a different hospital. Researchers found, after adjusting for variables, that heart failure patients who were treated at the same hospital were discharged a day sooner and were 11 percent less likely to die during their hospital stay.

In a news release from the American Heart Association, the study’s lead author, Finlay McAlister M.D., M.Sc, professor of general internal medicine at the University of Alberta in Edmonton, Canada, said, “Heart failure is a chronic condition and continuity of care seems to be more important.”

This is reassuring news for Cape residents with this condition. Not only are ambulance diversions to another hospital rare, but there also is a dedicated team of caregivers who work closely together to limit the possibility of information gaps, said cardiologist Elissa Thompson, MD, medical director of the Cape Cod Healthcare Heart Failure Clinic in Hyannis.

“We have implemented a plan and have developed a really robust heart failure clinic to help our patients remain outpatients. It is managed by a heart failure specialist nurse, who will see patients every day of the week if needed,” she said. “A few years ago, our readmission rate was 25-30 percent. Now it is down to less than 5 percent.”

Patient Records Are Important

The Canadian study’s authors surmised that when a heart failure patient is readmitted to another hospital, there are gaps in access to important patient records that negatively impact the quality of care. The result can be extra testing, medication changes and unnecessary treatments.

“One truth in medicine is, when you are transferring a patient from one place to another, there is always room for that patient to have less than adequate care because of a lack of information available to the clinician treating the patient at that time,” said Dr. Thompson. “What this study underscores is that it is important for as many caregivers as possible to have the same information at their finger tips, to work from. Otherwise, there is a lot of reinvention of the wheel.”

While potentially life-threatening cardiac episodes, like heart attack or stroke, are always treated at the closest emergency facility, the study’s authors suggest that it may not be the best way to handle patients with heart failure.

Improving readmission rates for heart failure patients takes a village, according to Dr. Thompson. It involves case managers, VNA, hospice and clinical pharmacologists who actually go to the patient’s home and reconcile the patient’s medications once they are out of the hospital.

“We have a very old and high-risk patient population. We are trying to address our unique community needs,” she said.

The American Heart Association estimates that there are 5.7 million Americans living with heart failure today. It is one of the most common reasons that people over 65 are admitted into the hospital.

How To Stay Healthy

So what can someone with heart failure do to remain as healthy as possible to avoid hospitalizations?

“Prevention, prevention, prevention,” said Dr. Thompson.

The most important thing you can do is to control the things that you can control:

  • Manage your glucose levels
  • Keep your blood pressure within normal limits, 120/80 mm Hg
  • Limit your sodium intake to 1500 MG a day or less
  • Lose weight, if obese

Be your own advocate or enlist a family member to help you, she said. Ask for copies of test results, like EKGs, and keep them in a folder just in case you end up in a different emergency room. This is especially important when traveling out of the area.

And work closely with the team at the Heart Failure clinic.

“What we can do is manage even the most delicate and highest risk patient,” said Dr. Thompson. “We can see them every day, if need be, to monitor weight loss and fluid. We will make sure they are taking their medicines. And we can review their access to healthy and appropriate foods. Assisting in making very simple lifestyle changes can be the difference between remaining home or being hospitalized.”