Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure

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Presentation transcript:

Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure Corey E. Tabit, MD, MBA, MPH, Mitchell J. Coplan, BS, Kirk T. Spencer, MD, Charina F. Alcain, DNP, ACNP-C, Thomas Spiegel, MD, MBA, MS, Adam S. Vohra, MD, MBA, Daniel Adelman, MS, PhD, James K. Liao, MD, Rupa Mehta Sanghani, MD The American Journal of Medicine Volume 130, Issue 9, Pages 1112.e17-1112.e31 (September 2017) DOI: 10.1016/j.amjmed.2017.03.044 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 Outline of the intervention. Patients with acute decompensated heart failure were identified on the medical ward after admission. All patients received standardized education, medication reconciliation, social needs assessment, and disposition assessment. At the time of discharge, patients were risk stratified. All patients received a telephone call from a nurse within 3 days of discharge and a cardiology and primary care physician (PCP) appointment within 7-14 days of discharge. Intermediate- and high-risk patients additionally received weekly telephone calls from a nurse for 4 weeks. High-risk patients received an additional clinic appointment 15-30 days after discharge. ADHF = acute decompensated heart failure; ED = emergency department. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Emergency department (ED) revisits (A) and the composite endpoint of ED revisits or death (B) within 90 days of discharge were not significantly different between the control and intervention groups. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 The intervention is associated with reduced re-hospitalization or death. Patients receiving the intervention had a significant reduction in (A) re-hospitalization and (B) the composite endpoint of re-hospitalization or death vs control patients and also (C) accumulated fewer re-hospitalized days within 90 days of index discharge. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 4 The intervention is associated with reduced health care cost. (A) Patients receiving the intervention consumed less total health care cost than control patients. (B) The cost of delivering the intervention to the 392 patients in this study for 90 days was $1.1 million less than the health care cost savings associated with the intervention. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure 1 Telephone questionnaire. Specially trained nurses used this standardized questionnaire to assess each patient's compliance, symptoms, and plans for follow-up after discharge. Abnormal responses triggered downstream actions as indicated. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure 1 Telephone questionnaire. Specially trained nurses used this standardized questionnaire to assess each patient's compliance, symptoms, and plans for follow-up after discharge. Abnormal responses triggered downstream actions as indicated. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure 1 Telephone questionnaire. Specially trained nurses used this standardized questionnaire to assess each patient's compliance, symptoms, and plans for follow-up after discharge. Abnormal responses triggered downstream actions as indicated. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure 1 Telephone questionnaire. Specially trained nurses used this standardized questionnaire to assess each patient's compliance, symptoms, and plans for follow-up after discharge. Abnormal responses triggered downstream actions as indicated. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure 2 Component costs within 90 days of discharge. For all component costs, the intervention was either lower or not significantly different from patients receiving usual care. (A) Inpatient cost; (B) Outpatient cost; (C) ED cost. The American Journal of Medicine 2017 130, 1112.e17-1112.e31DOI: (10.1016/j.amjmed.2017.03.044) Copyright © 2017 Elsevier Inc. Terms and Conditions