With support from a three-year, $2 million research grant from Patient-Centered Outcomes Research Institute (PCORI), Vanderbilt University Medical Center and the American Heart Association are teaming up to study heart failure care in the Emergency Department.
Patients who feel short of breath due to acute heart failure (AHF) commonly visit Emergency Departments (EDs). Nearly 200,000 patients with AHF are discharged annually from the the nation’s EDs, according to the American College of Cardiology Foundation. These patients often return to the hospital at a higher rate than inpatients with the same condition.
“Patients discharged from the ED after a visit for AHF are often unsure about their next steps to manage their care including the medications they should be taking and when they should follow up with their doctors,” said Sean Collins, M.D., MSc., associate professor of Emergency Medicine.
Collins is senior investigator of the study along with Javed Butler, M.D., MPH, of Stony Brook University.
The study goal is to improve outcomes for AHF patients discharged from hospital EDs by increasing patient knowledge about heart failure and reducing disparity gaps in patient care.
The Get With The Guidelines–HF (GWTG-HF) national initiative is a pre-discharge strategy meant to improve outcomes among patients discharged from the hospital with AHF. However, no such processes are in place for patients discharged from the ED; therefore, a similar initiative for improving outcomes of discharged ED patients has never been tested.
“When a patient is admitted to the hospital, we try to make sure the transition home is smooth by providing close follow-up, making sure they understand their medications and also educating them on the proper diet and exercise regime they should follow. This transition is set up well during the three-five days in the hospital,” Collins said.
“When a patient leaves the ED and returns to their environment, they have had less guidance regarding their care. We believe they will benefit from a more structured interaction with the health care system to define what they should and should not be doing for their heart failure.”
With input from patients who helped design the study, Collins adopted the GWTG-HF model from the inpatient setting and is implementing it in the study arm. Patients discharged from the ED receive guideline-based optimal medical therapy, arrange for follow-up care and receive disease education. A major component of this education is addressing health literacy. A nurse coordinator provides a home visit two days after discharge from the ED, and a heart failure specialist sees the patients in clinic one week following discharge.
Patients receive a phone call every two weeks to monitor progress, and these calls will continue for at least 90 days after discharge. The patients in this arm of the study will be compared to the patients discharged from the ED in the usual care arm without the GWTG-HF or transition program.
“We think the patients in the study will come back to the ED significantly less often. It will be less costly to the patients on multiple levels. They will feel better sooner, they can return to work and their daily routines faster and their overall quality of life will be improved,” Collins said.
JoAnn Lindenfeld, M.D., Russell Rothman, M.D., Jeffrey Blume, Ph.D., Dandan Liu, Ph.D., and Tiffany Israel, MSSW are on the Vanderbilt research team. Participating research sites include Wayne State University in Detroit; Indiana University in Indianapolis; and Stony Brook University in Stony Brook, New York.
“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI executive director Joe Selby, M.D., MPH. “We look forward to following the study’s progress and working with the American Heart Association and Vanderbilt University to share the results.”
PCORI is an independent, non-profit organization authorized by Congress in 2010 to fund comparative clinical effectiveness research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed health and health care decisions. PCORI is committed to seeking input from a broad range of stakeholders to guide its work.
