Purpose:

This project objective is a reduction in heart failure readmissions and ED encounters through education and initiation of appropriate self-care behaviors during hospitalization. A secondary purpose is to increase accuracy of daily weights for heart failure patients and consequently reducing length of stay.

Significance:

Heart failure is the only cardiac disease with increasing incidence and prevalence. It represents 15% of all Medicare hospitalizations and accounts for 40% of all Medicare dollars. In 2004, total direct costs for heart failure patients were $26.7 billion, with an additional $28.8 billion in indirect costs. Heart failure is also lethal, accounting for more than 266,000 deaths annually. The 5-year mortality rate approaches 50%, with 70% of women and 80% of men dying within 8 years of diagnosis. Nationally, 23% of heart failure patients are readmitted within 30 days of discharge from admission for decompensation. Our facility rate is approximately 20.3% with estimated un-reimbursed costs of more than $500,000 annually.

Background/Design:

Heart failure is the only cardiac disease with increasing incidence and prevalence. It represents 15% of all Medicare hospitalizations and accounts for 40% of all Medicare dollars. In 2004, total direct costs for heart failure patients were $26.7 billion, with an additional $28.8 billion in indirect costs. Heart failure is also lethal, accounting for more than 266,000 deaths annually. The 5-year mortality rate approaches 50%, with 70% of women and 80% of men dying within 8 years of diagnosis. Nationally, 23% of heart failure patients are readmitted within 30 days of discharge from admission for decompensation. Our facility rate is approximately 20.3%, with estimated un-reimbursed costs of more than $500,000 annually.

Methods:

The project is being piloted on the PCCU. Patients are screened for heart failure as the primary diagnosis, intact cognitive status, and the ability to stand to weigh. If all criteria are met, the patient is issued a solar digital scale for use for daily weights while admitted and for use at home after discharge; patients are encouraged to take responsibility for obtaining their own daily weight and reporting it to nursing staff. At the time of scale distribution, heart failure self-care education is conducted, emphasizing the importance/rationale for daily weights.

Findings:

The project has been underway for 9 weeks; 14 scales have been distributed. Four recipients agreed to obtain their own daily weight. There have been 3 readmissions: (1) pneumonia (readmit < 24 hours); (2) increased edema, chest pain-stents placed; and (3) heart failure exacerbation (readmit < 2 weeks). There have been no ED encounters among scale recipients.

Conclusions:

The outcomes confirm the importance of patient education in behavior compliance and symptom monitoring when living with heart failure.