Background

Heart failure with preserved EF ( HFpEF) is a condition common in the older population related to multiple co morbidities. According to “The Get With The Guidelines-Heart Failure “registry which was linked to Medicare administrative data (2006 - 2014) data that hospitalized patients with HFpEFa are ≥65 years of age. The final cohort included 53,065 patients with HFpEF and the overall 30-day mortality was 5.87%; at 1 year, it was 33.1%. The 30-day all-cause readmission rate was 22.2%, and it was 67.0% at 1 year. In a systematic review conducted by Kalogirou et al in 2020 on the effectiveness of Heart Failure Disease Management among HFpEF, they concluded that since patients with HFpEF are older and multi morbid, Disease Management Programs (DMP) should not rely on single disease focus but addresses predisposing presentations and a comprehensive geriatric assessment. Other components should include lifestyle modification. Based on evidence, DMP may improve mortality, hospitalization rates, self-care and quality of life. Our institution's, Heart Failure Disease Management (HFDM) team readmission data had been below the hospital and national average. We are not certain regarding the percentage of HFpEF population seen. The management of HFpEF is different and dependent on patient's co-morbidities.

Aim

The primary purpose of this project is to determine if the Heart Failure Disease Management (HFDM) team interventions made an impact among patients with HF Preserved Ejection Fraction in a single institution PICO question: Among patients hospitalized with HFpEF, did HFDM interventions reduce 30-day readmissions?

Methods

This is a quality improvement project conducted in a single tertiary 1000 bed hospital in the Texas Medical Center in 2022. Heart failure patients are referred to the HFDM primarily composed of a Nurse Practitioner in the acute setting. HFDM interventions include an individualized education with Mini Cog assessment for 65 years and over and low literacy evaluation. For patients with positive Mini Cog, family or caregiver was involved in the education. HF education was focused on self-adherence strategies, diet and fluid restriction, with provision of scale and BP if lacking. Barriers to adherence were evaluated and collaborated with Social Work, Case Management and Pharmacy if needed. Seven days post discharge follow up was scheduled with HFDM clinic if needed. For patients with HFpEF as well, the NP education focused on the precipitating co morbidity and risk factor modification.

Results

Total HF cases were 1758 in 2022 with the following ICD codes: 113.0,111.0, 113.2, 150.33,150.3 and 150. Due to the complexity of HFpEF and multi co morbidities, these ICD10 codes were included. We excluded combined systolic and diastolic HF. The readmission rate for the hospital was (n= 325) 19.14%. The HFDM saw 394 cases with a readmission rate of (n=57) 14.44%.

Conclusion

These data showed that HFDM specific interventions in the acute setting made an impact on 30-day readmission for HFpEF patients. Further data abstraction will be done on the specifics for quantification as well as their self-care and quality of life.

中文翻译：

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疾病管理干预措施对急性心力衰竭保留射血分数的影响

背景

EF 保留的心力衰竭 (HFpEF) 是老年人群中常见的一种疾病，与多种合并症相关。根据与 Medicare 管理数据（2006 年 - 2014 年）相关的“心力衰竭指南”登记数据，住院的 HFpEFa 患者年龄≥65 岁。最终队列包括 53,065 名 HFpEF 患者，总体 30 天死亡率为 5.87%；1 年时为 33.1%。30天全因再入院率为22.2%，1年时为67.0%。Kalogirou 等人于 2020 年对 HFpEF 心力衰竭疾病管理的有效性进行了系统评价，他们得出的结论是，由于 HFpEF 患者年龄较大且患有多种疾病，疾病管理计划 (DMP) 不应依赖于单一疾病焦点，而应解决诱发性陈述和全面的老年评估。其他组成部分应包括生活方式的改变。根据证据，DMP 可以改善死亡率、住院率、自我护理和生活质量。我们机构的心力衰竭疾病管理 (HFDM) 团队的再入院数据低于医院和全国平均水平。我们不确定 HFpEF 人群的百分比。HFpEF 的治疗方法各不相同，并且取决于患者的合并症。

目的

该项目的主要目的是确定心力衰竭疾病管理 (HFDM) 团队的干预措施是否对单个机构中射血分数保留的 HF 患者产生影响 PICO 问题：在因 HFpEF 住院的患者中，HFDM 干预措施是否减少了 30 天的射血分数重新入院？

方法

这是 2022 年在德克萨斯医学中心一家拥有 1000 个床位的三级医院开展的质量改进项目。心力衰竭患者被转诊至 HFDM，该中心主要由急诊护士组成。HFDM 干预措施包括针对 65 岁及以上人群的个性化教育和 Mini Cog 评估以及低识字率评估。对于 Mini Cog 阳性的患者，家人或护理人员参与教育。心力衰竭教育的重点是自我坚持策略、饮食和液体限制，如果缺乏，则提供量表和血压。评估依从性的障碍，并在需要时与社会工作、病例管理和药房合作。如果需要，可在 HFDM 诊所安排出院后 7 天的随访。对于 HFpEF 患者，NP 教育的重点是诱发合并症和危险因素修正。

结果

2022 年心力衰竭病例总数为 1758 例，ICD 代码如下：113.0、111.0、113.2、150.33、150.3 和 150。由于 HFpEF 的复杂性和多种合并症，这些 ICD10 代码也包含在内。我们排除了收缩期和舒张期合并心力衰竭。医院的再入院率为（n=325）19.14%。HFDM 共收治 394 例病例，再入院率为 (n=57) 14.44%。

结论

这些数据表明，急性情况下的 HFDM 特异性干预措施对 HFpEF 患者的 30 天再入院率产生影响。进一步的数据抽象将针对量化细节以及他们的自我护理和生活质量进行。