Heart failure education in the emergency department markedly reduces readmissions in un- and under-insured patients - 07/08/18

Doi : 10.1016/j.ajem.2018.03.057

Vishwaratn Asthana ^a,^{^⁎} , Miel Sundararajan, MD ^a, Ruth Linda Ackah ^a, Vivek Karun ^a, Arunima Misra, MD ^a, Allison Pritchett, MD ^a, Pallavi Bugga ^b, Angela Siler-Fisher ^a, William Frank Peacock, MD ^a
^a Baylor College of Medicine, United States
^b Rice University, United States

^⁎Corresponding author at: 1 Baylor Plaza, Houston, TX 77030, United States.1 Baylor PlazaHoustonTX77030United States

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Abstract

Background

Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients.

Methods

HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group. Eligible patients provided informed consent, had an established HF diagnosis, and were hemodynamically stable. Intervention patients received a standardized educational intervention in the ED waiting room before seeing the emergency physician, and a 30-day telephone follow-up. Primary and secondary endpoints were 30- and 90-day ED and hospital readmission rates, as well as days alive and out of hospital (DAOH) respectively.

Results

Of the 94 patients enrolled, median age was 58.4 years; 40.4% were female, and 54.3% were African American. Intervention patients (n = 45) experienced a 47.8% and 45.3% decrease in ED revisits (P = 0.02 & P < 0.001), and 60.0% and 47.4% decrease in hospital readmissions (P = 0.049 & P = 0.007) in the 30 and 90 days pre- versus post-intervention respectively. Control patients (n = 49) had no change in hospital readmissions or 30-day ED revisits, but experienced a 36.6% increase in 90-day ED revisits (P = 0.03). Intervention patients also saw a 59.2% improvement in DAOH versus control patients (P = 0.03).