Reducing Hospital Readmission among Heart Failure Patients

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Addressing Hospital Readmission among Heart Failure Patients
Name:
Institution:

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Study Details
Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing
Heart failure hospital readmissions: A systematic review of disease management
programs. Cardiology Research, 5, 126-138. http://dx.doi.org/10.14740/cr362w
A systematic literature review including randomized control trials that identified disease
management programs which help reduce heart failure patient hospital readmission. The study
included a comprehensive search of online databases such as EBSCOHost, Medline, and
Cochrane Library. Selection was mainly based on the Cochrane Handbook guidelines which led
to a collection of randomized studies with a minimum of 50 participants and reported on heart
failure disease management programs. The randomized trials were only those that compared the
mortality rates related to interventions and usual care or control, as well as outcomes related to
hospital readmissions. Data was analyzed by both thematic analysis and meta-analysis, where
themes on heart failure disease management programs were discussed to identify the most likely
program to reduce heart failure patient hospital readmission. Among in-home care, outpatient
visits, telemonitoring (invasive and non-invasive) and structured telephone support interventions,
the study found no specific program with a consistent benefit to heart failure and ability to
reduce hospital readmission. Ultimately, the study concluded that there are inconsistent results
associated with the efficacy of heart failure disease management programs; although this should
not be interpreted to mean that disease management programs for heart failure are ineffective.
Rather, applying one approach to a large number of patients may be erratic and therefore it is
important to tailor interventions to the health status of each patient.

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Molloy, G. J., O'Carroll, R. E., Witham, M. D., & McMurdo, M. E. T. (2012). Interventions
to enhance adherence to medications in patients with heart failure: A systematic
review. Circulation Heart Failure, 5, 126-133.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569
A systematic literature review that identifies summarizes and examines the effectiveness
of various interventions to promote adherence to medication among heart failure patients. The
review included randomized control trials comparing a control group with usual treatment.
Eligible studies were those that included adult (18 years and above) diagnosed with heart failure.
Self-administered medications were of major interest, and outcomes were measured through self-
reported data, prescription or refill data, electronic monitoring and pill count. The systematic
literature review was majorly based on the Cochrane Collaboration guidelines and the reviewed
articles were sourced from online databases including Medline, Cochrane, CINAHL, Embase,
and PsychInfo. Data was majorly collected by two researchers from the 16 selected studies to
eliminate bias of selection and to promote credibility. Quality was further ensured by following
the guidelines provided by Cochrane Reviewers Handbook, which included blinded outcome
assessment. Data was analyzed by grouping the main components of each intervention. As a
result, 8 of the 16 selected studies found that it is possible to enhance adherence to medication
among heart failure patients. It was also found that intensive patient care by pharmacists is
effective in ensuring adherence to medication. The study concluded that intensive patient care is
an effective intervention to promote adherence to medication by heart failure patients.

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Strömberg, A., Mårtensson, J., Fridlund, B., Levin, L-A., Karlsson, J-E., & Dahlström, U.
(2003). Nurse-led heart failure clinics improve survival and self-care behavior in
patients with heart failure: Results from a prospective, randomized trial. European
Heart Journal, 24, 1014-1023. http://dx.doi.org/10.1016/S0195-668X(03)00112-X
This study is a randomized control trial where a total of 106 patients were assigned to
usual care or follow-up at a heart failure health facility. The main aim of the study was to explore
the effects of follow-up on morbidity, mortality and self-care behaviors of heart failure patients.
The study involved qualified cardiac nurses who visited heart failure patients and assessed their
status, provided education about heart failure and gave social support to the patients and their
families. The nurses had to be qualified cardiac nurses with experience in cardiac-related
medications and the protocols related to changing such medications. The study found fewer
admissions and death events among the intervention group as compared to the control group. The
intervention group also had fewer days in hospital and fewer admission cases. It was concluded
that follow-up interventions after hospitalization can reduce the days spent in the hospital,
number of readmissions and number of heart failure events experienced by heart failure patients.
Justification of Choice of Study
The case study at hand involves a 75-year old man who is readmitted into the hospital
two years after being diagnosed with chronic heart failures triggered by hypertension and
ischemic cardiomyopathy. The patient complains of feeling increasingly unwell and is seeking
medical attention. While hospital readmission has largely been associated with heart failure
complications, studies by Gorthi et al 2014, Molloy et al 2012 and Stromberg et al 2003 give