title: Impact of Enhanced External Counterpulsation on Heart Failure Rehospitalization in Patients With Ischemic Cardiomyopathy.
abstract: Heart failure (HF) affects millions of Americans and causes financial burdens because of the need for rehospitalization. For this reason, health care systems and patients alike are seeking methods to decrease readmissions. We assessed the potential for reducing readmissions of patients with postacute care HF through an educational program combined with enhanced external counterpulsation (EECP). We examined 99 patients with HF who were referred to EECP centers and received heart failure education and EECP treatment within 90 days of hospital discharge from March 2013 to January 2015. We compared observed and predicted 90-day readmission rates and examined results of 6-minute walk tests, Duke Activity Status Index, New York Heart Association classification, and Canadian Cardiovascular Society classification before and after EECP. Patients were treated with EECP at a median augmentation pressure of 280 mm Hg (quartile 1 = 240, quartile 3 = 280), achieved as early as the first treatment. Augmentation ratios varied from 0.4 to 1.9, with a median of 1.0 (quartile 1 = 0.8, quartile 3 = 1.2). Only 6 patients (6.1%) had unplanned readmissions compared to the predicted 34%, p <0.0001. The average increase in distance walked was 52 m (18.4%), and the median increase in Duke Activity Status Index was 9.95 points (100%), p values <0.0001. New York Heart Association and Canadian Cardiovascular Society classes improved in 61% and 60% of the patients, respectively. In conclusion, patients with HF who received education and EECP within 90 days of discharge had significantly lower readmission rates than predicted, and improved functional status, walk distance, and symptoms.
authors.affiliation: Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Tecson
authors.affiliation: Department of Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Silver
authors.affiliation: UT Medicine Cardiology, UT Medicine, San Antonio, Texas.
authors.forename: Sonja D
authors.initials: SD
authors.lastname: Brune
authors.affiliation: Dell Medical School, Seton Heart Institute, Austin, Texas.
authors.forename: Clay
authors.initials: C
authors.lastname: Cauthen
authors.affiliation: Advanced Heart Failure and Cardiac Transplant Program, MHS Health, San Antonio, Texas.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kwan
authors.affiliation: Division of Cardiology, Baylor University Medical Center, Dallas, Texas.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Schussler
authors.affiliation: Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Anupama
authors.initials: A
authors.lastname: Vasudevan
authors.affiliation: Cardiology Division, Brooke Army Medical Center, San Antonio, Texas.
authors.forename: James A
authors.initials: JA
authors.lastname: Watts
authors.affiliation: Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Division of Cardiology, Baylor University Medical Center, Dallas, Texas; Division of Cardiology, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas; Division of Cardiology, The Heart Hospital Baylor Plano, Plano, Texas. Electronic address: peteramccullough@gmail.com.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015908:Counterpulsation / Q000379:methods; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011788:Quality of Life; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D016138:Walking