Author + information
- Nisha Aggarwal Gilotra,
- Kimberly Cuomo,
- Abby Cummings,
- Bonnie Marino,
- Parker Rhodes,
- Johana Almansa,
- Julianne Chambers,
- Tasha B. Freitag,
- Tolulope Adesiyun and
- Stuart Russell
Background: HF hospitalizations contribute to a tremendous expenditure. Post-discharge HF patients are highly vulnerable to early readmission. In 2012, we established a nurse practitioner (NP) managed HFBC, which provides post-discharge follow-up, guideline-directed HF care, intravenous (IV) diuretics, laboratory testing, education, pharmacy visits and palliative care.
Methods: This was an observational study of HFBC patients from May 2014-July 2016.
Results: Of 5070 clinic visits, 1336 unique patients were seen an average 3.8±4.3 times. IV furosemide was administered 728 times to 300 patients (Table 1), average 3.7±3.8 times per patient. Mean furosemide dose was 129±43 mg, with 81 metolazone, 436 potassium and 350 magnesium administrations. There were 78 HF medication and 377 oral diuretic uptitrations. Post-diuretic urine output was 614±407 mL and weight decreased by 0.61±0.85 kg. 51 (7%) of diuresis visits resulted in need for further management via ER or direct admission. The 30 day all-cause readmission rate for HFBC patients was 12.8% (expected 24.4% based on academic medical centers risk score) compared to 31.9% for those not seen in HFBC.
Conclusions: We describe successful implementation of a comprehensive HF disease management program with the ability to safely provide IV diuretics. This NP-managed program was associated with significant reductions in readmissions, with implications for significant cost savings to hospital systems.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-266
- 2017 American College of Cardiology Foundation