Abstract 17077: Impact of Comprehensive Heart Failure Program on Emergency Department Visits - Experience From Urban Academic Center
Background: Acute heart failure syndrome is a leading cause for hospital admission (AD) and a major source for healthcare dollar expenditure. Likewise emergency department visits (ED) contributes to healthcare resource utilization. Although comprehensive heart failure programs (CHFP) have been shown to reduce AD, their impact on ED visits is unclear. We performed this study to determine the effect of CHFP on ED visit and hospitalization in a public hospital serving predominantly minority population.
Methods: CHFP (intervention) comprising focused education, medication optimization, symptom management, transitional and remote care was evaluated in a HF patient cohort. The study population consisted of consecutive patients entered into a registry created for performance improvement between March 2011 and February 2012. CHFP was implemented by mid level providers supervised by a cardiologist. Patients were enrolled in the registry from multiple sources but majority were enrolled as part of the post hospital discharge plan. Demographic and clinical variables were acquired before and after intervention. Outcomes variable were ED visits and hospitalizations for HF. Each patient served as control in assessing the impact of the intervention on ED visits and hospitalization. Standard statistical methods were employed in data analysis.
Results: A total of 360 patients were enrolled in the registry in the first year, predominantly from inpatient service (78%). Cohort (median age=57 years) was dominated by AA race (93%), male gender (65%), HFrEF (60%) and non-ischemic (61%) etiology. We excluded 60 patients who did not complete the CHFP, leaving a final study cohort of 300 patients. CHFP resulted in significant reduction in all cause ED visits: 37% (245 vs. 154; P<0.001), total admissions: 51.5% (612 vs.297; P<0.001), HF admissions: 65.8% (418 vs. 143; P<0.001) and 30 day HF admissions: 53.1% (81 vs.38; P<0.002). There was no significant reduction in non-HF admissions (193 vs 153; P=0.271)
Conclusions: ED visits are common and decreased significantly after CHFP was implemented by mid level providers. A non significant increase in 30 day non HF admissions was also observed. Further studies are needed.
- © 2013 by American Heart Association, Inc.