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How to keep heart failure patients out of the hospital

Engaging patients in their own self-care helps keep them at home

November 2023
managing-heart-failaure-home

AS THE LEADING cause of hospitalizations among older adults, congestive heart failure is also the one condition that racks up the highest number of 30-day readmissions, with national readmission rates topping 20%. That used to be the case at Griffin Hospital in Derby, Conn., where Olugbenga Arole, MD, chief of hospital medicine, says the readmission rate for heart failure patients in his hospital used to be a whopping 20.7%.

But what to do? Studies have found that invasive systems—implants measuring pulmonary artery pressure—that send readings to clinicians remotely from patients’ homes help prevent readmissions. “But those systems aren’t widely available,” Dr. Arole points out. “Plus, they’re expensive.”

Griffin Hospital looked at various noninvasive remote monitoring systems and settled on a kit from VitalTech that transmits data on patients’ blood pressure, pulse rate, oxygen and temperature. Beginning in late 2021, a nurse navigator who deals only with heart failure patients in the hospital began recruiting patients to sign on for remote monitoring for 30 days.

“Patients aren’t waiting for their condition to deteriorate before they take action to improve their health.”

arole-md

Olugbenga Arole, MD
Griffin Hospital

 

Two years later, that program is still going strong—and it’s delivered big benefits. According to Dr. Arole, the 30-day readmission rate for patients in the monitoring program has been cut by more than half, down to 8%. While patients are being monitored for 30 days, most readmissions take place within the first two weeks after discharge.

How it works
When recruiting heart failure patients in the hospital before discharge, the nurse navigator spends 10 to 15 minutes training them to use the devices. The monitoring system connects wirelessly to both the patient’s smartphone and to a dashboard center at the hospital.

At home, patients weigh themselves and connect with the provided devices. Dr. Arole says that engagement helps improve outcomes and patient satisfaction. (See “Program parameters,” below.)

Feedback from patients’ devices is monitored Monday through Friday. When the team that oversees the incoming data sees changes, staff call patients.

That population health team also sends patient readings to providers so they can see trends and adjust treatment plans accordingly. “Patients get feedback on what to do, whether it’s increasing their diuretics, changing their diet, or going to an ER or a specialist’s or primary care office,” Dr. Arole explains. “That way, patients aren’t waiting for their condition to deteriorate before they take action to improve their health.”

For the patients enrolled in the program, he added, “that’s a big satisfier.”

Program challenges
Since the program began, the hospital has identified several barriers to its smooth performance and come up with some solutions.

While compliance has been an issue, patients now receive frequent reminders to connect to the system and transmit data.

Also, the hospital initially didn’t have a clear action plan to interpret the data it received and respond to alerts. “That’s when we standardized our response so our population health team in the hospital monitoring center receives the alerts and reaches out to patients’ physicians,” Dr. Arole says.


For ways not to manage heart failure, read Tough choices: the right diuretic for heart failure and the best test for chest pain.


Physicians at the hospital also worked with cardiologists to formalize and validate the algorithms used to manage how to interpret the system data.

But the biggest barrier occurs earlier in the process when convincing patients to sign up for 30 days. “They’re reluctant to sign up,” says Dr. Arole. “It’s a combination of something that’s new that they’re not used to and a low comfort level with the technology.”

It is worth it, he adds, to keep on clearing that hurdle. “We can strongly endorse that this is effective,” he says. “This has positively reduced readmission outcomes for patients.”


Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Program parameters

IN ITS NONINVASIVE remote monitoring program for patients with congestive heart failure, clinicians at Griffin Hospital in Derby, Conn., have set the following parameters as standard:

  • BP: 100-160/60-100 mmHg.
  • Pulse rate: 60-100/min.
  • SpO2: > 92% on room air.
  • Temperature: 97-100.4 F.
  • Weight gain: no more than 3 lbs/day or 5 lbs/week.
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