Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?
Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.
Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada.
Richard
R
Dunbar-Yaffe
Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada.
Audra
A
Stitt
Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada.
Joseph J
JJ
Lee
Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Shanas
S
Mohamed
Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada. dlee@ices.on.ca.|Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. dlee@ices.on.ca.|Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. dlee@ices.on.ca.
Douglas S
DS
Lee
D000553:Ambulatory Care / Q000379:methods; D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods
Health policy; Health services delivery; Heart failure; Hospital; Outcomes; Prevention; Readmission; Risk prediction