Heart failure is a leading cause of hospital admission in the United States, and after declining for several years, hospitalizations and readmissions are once again on the rise. According to a recent study in JAMA Cardiology, overall primary hospitalization rates for heart failure per 1,000 adults declined from 4.4 in 2010 to 4.1 in 2013, but then began to creep up to 4.9 in 2017. The rising trend was seen for both unique index hospital admissions and for postdischarge readmissions.

Rates of unique patient visits for heart failure dropped from 3.4 in 2010 to 3.2 in 2013 and 2014, but then rose to 3.8 in 2017. Similar trends were observed for readmissions, which declined from 1 in 2010 to 0.9 in 2014 and then rose to 1.1 in 2017, as well as for all-cause 30-day readmissions (0.8 in 2010 to 0.7 in 2014 to 0.9 in 2017).

The reasons for this upward trend are unclear, though longer life spans and comorbidities are thought to be contributing factors. "I believe people are living longer with heart failure, and with that longer life span comes more comorbidities, which results in sicker patients," said Linda Wick, senior director of ambulatory nursing and senior operations director of cardiology and cardiovascular surgery at M Health in Minneapolis. "This extends the length of stay and also readmissions, as they may not be rehospitalized for heart failure but for another comorbidity."

The study on heart failure hospitalizations included the finding that comorbidities affecting heart failure also climbed during the study period. By 2017, hypertension was present in 91.4% of patients, diabetes in 48.9%, and lipid disorders in 53.1%, a rise from 2010 rates of 76.5%, 44.9%, and 40.4%, respectively. Renal disease also jumped from 45.9% in 2010 to 60.6% by 2017.

Nurses have an opportunity to stem the rise in heart failure with multidisciplinary case management. "What nursing can do is support patients in the ambulatory setting with holistic care coordination, meaning not just focusing on one disease state, given the multiple comorbidities these patients have," said Wick. "It will mean coordinating care across several specialties."

Beth Towery Davidson, director of the heart failure disease management program at TriStar Centennial Medical Center in Nashville, Tennessee, made a similar case for comprehensive nurse management, noting that "nurses are in key positions to advocate for appropriate, guideline-driven treatment as well as clinical trials that include the entire heart failure population," including those with reduced, preserved, and mid-range ejection fraction.-Roxanne Nelson