What strategies can be used to manage discharged congestive heart failure patients to prevent readmissions?

From the Guidelines

To prevent readmissions in discharged congestive heart failure patients, using advanced practice providers as part of a multidisciplinary team to manage and educate patients is crucial. This approach should include medication management, education on self-care, and regular follow-up appointments. Patients should be placed on guideline-directed medical therapy, including ACE inhibitors or ARBs, beta-blockers, and diuretics, as well as SGLT2 inhibitors and mineralocorticoid receptor antagonists for those with reduced ejection fraction, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.

Key components of the management plan include:

• Medication adherence and optimization
• Daily weight monitoring and reporting gains of 2-3 pounds in 24 hours
• Sodium restriction to 2000 mg daily
• Fluid restriction to 1.5-2 liters daily
• Recognizing worsening symptoms

A follow-up appointment should be scheduled within 7 days of discharge, with regular subsequent visits. Remote monitoring programs using telehealth or home visits can help detect early signs of decompensation. The involvement of advanced practice providers, along with cardiologists, primary care providers, nurses, pharmacists, and dietitians, ensures comprehensive care and can lead to improved patient outcomes, as supported by the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.

Education on self-care is a critical component, and resources such as those provided by the American Heart Association and the Heart Failure Society of America can aid in implementation 1. By prioritizing a multidisciplinary approach and patient education, the risk of readmissions can be significantly reduced, and the quality of life for patients with congestive heart failure can be improved.

From the Research

Strategies to Manage Discharged Congestive Heart Failure Patients

To prevent readmissions, several strategies can be employed to manage discharged congestive heart failure patients. These include:

• Comprehensive discharge planning with postdischarge support, which has been shown to reduce readmission rates and improve health outcomes such as survival and quality of life without increasing costs 2
• Discharge counseling, which is critical in optimizing adherence and outcomes for patients with heart failure or myocardial infarction 3
• The use of advanced practice providers, such as pharmacists, who can play a significant role in reducing readmissions by ensuring appropriate evidence-based pharmacotherapy regimens and performing medication reconciliation 3
• Patient-centered interventions, such as palliative care, that focus on addressing patient-centered factors, including uncertainty, hopelessness, and frustration, which can contribute to readmissions 4

Medication Management

Medication management is also crucial in preventing readmissions for congestive heart failure patients. This includes:

• The use of ACE inhibitors, such as lisinopril, which has been shown to reduce the risk of major clinical events and improve symptomatic end-points and clinical status in patients with heart failure 5
• The use of beta-blockers, which have become a cornerstone in the treatment of systolic heart failure, alongside ACE-inhibitors, and have been shown to reduce all-cause death by 34-5% 6
• Ensuring that patients are adhering to their medication regimens and addressing any potential issues or concerns they may have 3

Patient Education and Support

Patient education and support are also essential in preventing readmissions for congestive heart failure patients. This includes:

• Educating patients on their condition, treatment options, and self-care strategies, such as diet and lifestyle modifications 3
• Providing patients with support and resources to help them manage their condition, such as access to advanced practice providers and patient-centered interventions 4, 2