Preventing heart failure hospital readmissions: Challenges and opportunities
Heart failure (HF) is a leading cause of hospitalization and readmission. As evidence-based treatments for the management of HF with reduced ejection fraction have evolved, the ability to reduce the HF readmission risk has improved. Clinical trials have shown measurable improvements in patient-centered outcomes through exercise, pharmacologic, and device therapies. In contrast, for HF with preserved ejection fraction, no medical therapy has been identified that improves survival, though aldosterone antagonists may reduce HF hospitalization risk. Thirty-day readmission rates have become a metric for hospital quality and financial penalties in the United States; however, reducing all preventable hospitalizations, improving health status, and prolonging survival should be the goal for HF patients. Nearly half of repeat hospitalizations for HF are secondary to noncardiovascular conditions. Careful attention to complicating comorbid conditions should be assessed before discharge for an acute decompensation. Optimizing the outpatient management of HF and providing careful transitions from the hospital to the outpatient setting are critical to minimizing readmission risk and improving patient-centered outcomes.