Hospital readmission rates for people with heart failure are a major concern in the healthcare continuum. There are currently penalties and fines against hospitals for exceeding certain readmission percentages and experts are looking at ways to keep people from returning to the hospital within 30 days of being released.
“It’s a changing playing field,” said Robert Bonow, MD, past president of the American Heart Association and national spokesman and the Goldberg Distinguished Professor of Cardiology, Director, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital. “We used to see 28 percent readmission rate, and a lot of hospitals now are reporting declining numbers because of penalties.” In other words, the penalties seem to have motivated hospitals to make a variety of changes that are leading to a decrease in readmissions.
Dr. Bonow is quick to point out that statistics on readmission rates can be misleading as the readmission may be due to something unrelated to the patient’s heart failure. Many of the reasons for readmissions are avoidable with proper follow up care.
“People may be readmitted because of an unrelated chronic condition, a fall in the home, it’s difficult to predict,” he said. “It’s really multifactorial. A patient can be sent home with the right medications and on the outpatient side there is not an understanding of the medications.”
Right Medications, Wrong Understanding
Not understanding medications could be anything from not being able to read or speak English, Dr. Bonow said, to not understanding dietary restrictions that come along with the medications.
For example, warafin (which sold under the brand names Coumadin and Jantoven) is a common medication for people who have had a heart attack and it can prolong their life. The American Heart Association describes the benefits on their website. “Warafin is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a heart attack, stroke, deep vein thrombosis or pulmonary embolism. Because warfarin interferes with the formation of blood clots, it is called an anticoagulant. Many people refer to anticoagulants as “blood thinners”; however, warfarin does not thin the blood but instead causes the blood to take longer to form a clot.”
Keeping in mind this is just one of the important medications a patient returns home to self-administer, this one small pill has an array possible side effects and the AHA notes, “Many medications can alter the effectiveness of warfarin, resulting in an INR that is either too high or too low. Some of the most common over-the-counter pain relievers, such as: ibuprofen (brand name Advil) and naproxen (brand name Aleve), enhance the anticoagulant effects of warfarin and increase the likelihood of harmful bleeding.” Furthermore, foods high in vitamin K—such as green and leafy vegetables like spinach and broccoli—can make warafin less effective and potentially increase the risk of blood clots. Yet, the AHA also tells people it is not necessary to avoid these foods while taking warafin.
Falls are an even greater risk to heart failure patients who are on warafin, and it is recommended that people taking it avoid activities that include a fall risk.
“There are lots of things in play here,” said Dr. Bonow of the many reasons that heart failure patients might be readmitted to the hospital within 30 days. “ I think the more important point is that we understand this is a huge burden for Medicare and we don’t understand fully what the cause is so there is no one size fits all approach to know how we should prevent this.”
Family caregivers and professional in home care can help people with heart failure reduce the possibility of a hospital readmission within 30 days of being released from the hospital—whether in the form of medication reminders, doing a fall risk assessment of the home and subsequently removing fall hazards, managing diet or driving someone to the doctor for follow up appointments.