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Nationwide, 25% of patients admitted to US hospitals for decompensated heart failure are readmitted within 30 days. Reducing these readmissions has been a target of many, including a recent move by Medicare to penalize hospitals with excessive readmission rates. The Joint Commission (JCo) requires hospitals to provide each patient admitted for heart failure with discharge instructions that address six topics: diet, exercise, weight monitoring, worsening symptoms, medications and follow up appointments. These guidelines were developed based on expert opinion, but to date no one has tested whether a patient's understanding of these instructions affects 30-day readmission rates.
We conducted a prospective cohort study among patients admitted to the hospital for heart failure. Patients completed an assessment survey immediately after their nurse had read their discharge papers. The survey contained one question for each of the six JCo categories; patients were allowed to refer to their discharge instructions when answering.
Of the first 71 patients (66±15 years, 54% male, average of 3-4 co-morbidities and taking 10±4 medications) only 5 (7%) understood all 6 aspects of their discharge papers. Almost all (97%) knew what do if symptoms worsened, 82% knew the importance of daily weights, 65% understood diet and exercise recommendations, 53% correctly identified follow-up appointments and only 15% knew all their medications. 21 (30%) were readmitted within 30 days. The only independent predictor of readmission was whether subjects knew all of their discharge medications (OR 0.65; 95% Cl: 0.54-0.78). Patients who were not readmitted knew 59% ± 37% of their medications, while those who were readmitted knew 33% ± 37% of theirs, a statistically significant difference (p<0.05). 28% of patients were unable to name any discharge medications correctly.
There appear to be significant barriers to heart failure patients’ comprehension of the 6 JCo specified aspects of discharge papers. Since understanding of the medication regimen was the only independent factor to predict 30-day readmissions, further focus on this aspect of transitional care appears critical.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Lessons Learned from Acute Decompensated Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1175-286
- 2013 American College of Cardiology Foundation