The Revolving Door of Heart Failure Hospitalization

TUESDAY, Nov. 10 (HealthDay News) — Almost a quarter of the people on Medicare who are hospitalized for heart failure are back in the hospital within a month of discharge, a new study reveals.

That should not be happening, said Dr. Joseph S. Ross, an assistant professor of geriatrics and palliative medicine at the Mount Sinai School of Medicine in New York City, who added that there’s plenty of blame to go around. Ross was lead author of the study, published online Nov. 10 in Circulation: Heart Failure.

“It’s not just an issue for physicians,” Ross said. “The whole clinical team, nurses, pharmacists, even patients play a role. If we want to do better, everyone has to get in the game together.”

Heart failure, which is the progressive loss of the heart’s ability to pump blood, affects an estimated 5.7 million people in the United States, with 670,000 new cases diagnosed every year, and is one of the more common reasons for hospitalization, according to the American Heart Association.

Hospitalization affords the chance to get treatment for heart failure properly organized, Ross said. But he added that the high re-admission rate found by the study — more than half a million a year from 2004 through 2006 — shows that this often is not done.

“The challenge is that there are multiple physicians involved — the physician who manages the person as an outpatient, the cardiologist, the primary care physician,” he said. “They have to touch base and make sure the patient has all the proper medications, that if they start to get sick again, if there are any red flags, proper treatment is started.”

But too often, trouble means an emergency room visit, “and the emergency room admits them to the hospital without coordinating with the physician,” Ross said.

Measures must be taken before someone is discharged from the hospital, he said. “Physicians and the hospital have to work together to make sure the patient has a smooth discharge out of the hospital, knows how to manage the disease, how to get in touch with the pharmacist, how to take the medications, knows how to eat,” Ross said.

To remedy the problem, he has two suggestions. “One is that there needs to be incentives to help encourage physicians and hospitals to work together,” Ross said. “There is this proposed Medicare move toward bundled payment — one lump sum for all hospital care and 30 days afterward — so that hospitals and physicians have to work together.”

Second, there are “existing programs that we know work,” Ross said. “We can pay physicians to make phone calls just to touch base with the patient and also reimburse them for e-mail. That would allow patients better communication with physicians, but they are not reimbursed in the current situation.”

Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, and a spokesman for the American Heart Association, said that efforts are under way to reform the current system.

He cited a Heart Association initiative, dubbed “Target: Heart Failure,” that he said was “designed to improve clinical care for patients hospitalized for heart failure” and also an American College of Cardiology program, called “H2H,” for hospital-to-hospital, “which helps hospitals work together to lower the 30-day readmission rate.”

Also, the health-care reform effort now under consideration in Congress includes provisions for pilot programs to improve “these pretty dismal outcomes and mortality rates,” Fonarow said.

But the existing situation “is in a sense shocking — that despite all the advances for heart failure treatment, patients have not reaped the benefits,” Fonarow said. “What is behind this remains one of the biggest challenges for cardiology.”

“The most effective therapies, such as beta blockers, are underused, and when they are used, are applied at lower doses than are shown to be effective in clinical trials,” he said. “So, many of these patients end up bouncing in and out of hospitals, not receiving important therapies at the right doses and not getting proper monitoring.”

More information

The American Heart Association has more about heart failure.