Author + information
- Vishwaratn Asthanaa,b,
- Miel Sundararajana,b,
- Vivek Karuna,b,
- Ruth Ackaha,b,
- Arunima Misraa,b,
- Allison Pritchetta,b,
- Angela Siler-Fishera,b and
- W. Frank Peacocka,b
Background: Previous studies report conflicting results on the effectiveness of educational intervention in patients with heart failure (HF). The purpose of this pilot study was to evaluate the efficacy of a structured educational intervention targeted towards un- and underinsured patients presenting to the emergency department (ED) for acute HF.
Methods: 115 predominately un- and underinsured patients arriving for an acute exacerbation of HF were selected from a large urban county hospital ED waiting room. The current study implements elements from both a randomized controlled trial, with patients being randomly assigned to either an intervention (45 patients) or control (70 patients) group, and single-subject design, with outcome measures being collected before and after patient enrollment. Patients in the intervention group received targeted education while waiting in the ED, in addition to a telephone follow-up 30-days post-discharge; patients in the control arm received usual care. Change in the number of ED and hospital readmissions in the 90-day window pre- and post-intervention served as primary outcomes, while days alive and out of hospital (DAOH) post-intervention served as a secondary outcome.
Results: Of the 115 patients enrolled, 111 were un- or underinsured. Median age was 58; 38.3% were female, 52.2% were African American, and 36.5% were Hispanic. Patients in the interventional arm had a markedly lower number of ED (0.80 vs 1.43; P < 0.05) and hospital (0.45 vs 0.84; P < 0.05) revisits in the 90-days post-intervention versus pre-intervention, representing a 44.4% and 45.9% reduction respectively. Patients in the control arm had an increased number of ED revisits in the 90-days post-intervention (1.81 vs 1.27; P < 0.05) corresponding to a 42.0% increase. Hospital revisits in the control arm showed no statistically significant change (0.67 vs 0.62; P = 0.74). Patients in the interventional arm also saw a 41% improvement in DAOH (187 vs 133; P < 0.05) relative to their control arm counterparts.
Conclusions: Among un- and underinsured HF patients, targeted educational intervention delivered in the ED waiting room can markedly decrease 90-day ED and hospital revisits while improving DAOH.
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: 1163-272
- 2017 American College of Cardiology Foundation