Author + information
- Robin Fortman,
- Gopi Astik,
- Preeti Kansal,
- Hannah Alphs Jackson,
- Daniel Navarro,
- Allen Anderson,
- Charles Davidson,
- Clyde Yancy and
- Raja Mutharasan
Background: Transitional care interventions hold promise for improving outcomes for hospitalized heart failure patients. To facilitate early initiation of transitional care, we constructed an enterprise data warehouse (EDW) screen to detect patients with acute decompensated heart failure (ADHF). We sought to characterize the sensitivity of this algorithm for ADHF.
Methods: An EDW query identified potential ADHF cases using parameters including: any administration of intravenous diuretics, B-type natriuretic peptide level greater than 100 pg/ml, cardiology consultation order, reason for telemetry initiation of heart failure, and presence of carvedilol on the medication list. The query was run each weekday; expert clinicians verified the diagnosis of ADHF based on comprehensive chart review. Using patients coding into a discharge diagnosis-related group (DRG) of heart failure as the gold standard, we computed the sensitivity of the EDW screen for ADHF, and also the sensitivity of clinician chart review of the EDW screen output for ADHF.
Results: During the study period of 366 days, a total of 632 patients coded into heart failure DRGs. The algorithm correctly identified 619/632 patients for a sensitivity of 97.9%. Of the remaining 619 patients, 600 were correctly classified as potential ADHF cases by clinicians, yielding an overall sensitivity of the screening strategy of 600/632 or 94.9%.
Conclusions: EDW-based screening of patients based on simple clinical parameters early in the hospitalization is highly sensitive for detection of ADHF hospitalization. Admission chart review by expert clinicians is rapid, and identifies a specific cohort of patients that can be targeted for multidisciplinary transitional care interventions. Ongoing work to validate this screen at other centers will demonstrate the translatability of this approach. Ongoing process improvements will demonstrate if early identification of at-risk patients yields significant reduction in HF readmissions.
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: 1163-278
- 2017 American College of Cardiology Foundation