title: Impact of a Multidisciplinary Heart Failure Post-hospitalization Program on Heart Failure Readmission Rates.
abstract: BACKGROUND
  Specialized chronic heart failure (HF) clinics have demonstrated significant reductions in readmissions. Limited evidence is available regarding HF clinics in the immediate post-discharge period.
  
  
  OBJECTIVE
  To evaluate the effect of a multidisciplinary HF clinic on 90-day readmission rates and all-cause mortality in those recently discharged from a HF hospitalization.
  
  
  METHODS
  In this retrospective cohort study, patients discharged with a primary HF diagnosis who attended the HF postdischarge clinic in 2010-2012 were compared with controls from 2009. During 6 clinic visits, patients were seen by a physician assistant, clinical pharmacist specialist, and case manager, with care overseen by a cardiologist. The program focused on optimizing therapy, identifying HF etiology/precipitating factors, medication titration, education, and medication adherence. The primary outcome was 90-day HF readmission. A multivariate Cox proportional hazards model was used to compare outcomes.
  
  
  RESULTS
  Among the 277 patients (144 clinic, 133 control) in the study, 7.6% of patients in the clinic and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR (adjusted hazard ratio) = 0.17; 95% CI = 0.07-0.41; P < 0.001; ARR (absolute risk reduction) = 15.7%; NNT (number needed to treat) = 7). Clinic patients had lower 90-day time-to-first HF readmission or all-cause mortality (9.0% vs 28.6%; aHR = 0.28; 95% CI = 0.06-0.31; P < 0.001; ARR = 19.6%; NNT = 6).
  
  
  CONCLUSIONS
  The multidisciplinary HF posthospitalization outpatient program was associated with a significant reduction in 90-day HF readmissions in patients who were recently discharged from a HF hospitalization.
authors.affiliation: Western University of Health Sciences, Pomona, CA, USA VA Greater Los Angeles Healthcare System, CA, USA Institute for Clinical Evaluative Sciences, Toronto, ON, Canada University of Toronto, ON, Canada University Health Network, Toronto, ON, Canada Cynthia.jackevicius@va.gov.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.affiliation: University of California, San Francisco Medical Center and School of Pharmacy, San Francisco, CA.
authors.forename: Noelle K
authors.initials: NK
authors.lastname: de Leon
authors.affiliation: VA Greater Los Angeles Healthcare System, CA, USA California Northstate University College of Pharmacy, Elk Grove, CA.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Lu
authors.affiliation: VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Chang
authors.affiliation: VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA.
authors.forename: Alberta L
authors.initials: AL
authors.lastname: Warner
authors.affiliation: VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA.
authors.forename: Freny Vaghaiwalla
authors.initials: FV
authors.lastname: Mody
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010351:Patient Discharge; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: heart failure; hospitalization; readmission