A national study led by researchers at Vanderbilt University Medical Center has found that many patients who arrive at the emergency department (ED) with acute heart failure can be safely discharged with self-care guidance and frequent phone appointments, avoiding the need for hospitalization.
Every year in the United States, more than 1 million patients come to the ED with acute heart failure. More than 80% are hospitalized, even though many are not at high risk of severe complications or death.
Avoiding unnecessary hospitalizations by providing self-care interventions to these patients could save the nation’s health care system millions of dollars a year, said Sean Collins, MD, professor of Emergency Medicine at VUMC and principal investigator of the clinical trial, the results of which were published recently in JAMA Cardiology.
“It’s not … some new medication or a new device,” Collins said. “It’s empowering patients to be their own coaches and educating them.”
The study included 471 heart failure patients treated at 15 academic medical center EDs across the country.
Patients with acute heart failure who were discharged from the ED were randomly assigned to receive usual care or a 90-day post-discharge intervention of a home visit and biweekly coaching calls that covered diet, weight and medication management, and education about their disease.
Thirty days after ED discharge, heart failure health status and clinical outcomes were significantly improved in patients who’d received the post-discharge intervention. The additional benefit of intervention was not sustained, however. By 90 days there was no difference in outcomes between the two groups.
Perhaps, Collins said, the improvement in health status could be extended if the intervention was continued beyond 30 days. Toward that end, he and his colleagues are planning to implement their intervention model in other locations to try to replicate or improve their findings.
The study also found that death rates were lower than expected in both the control and intervention group, no matter the patient’s socioeconomic or health literacy status.
This supports the contention that many heart failure patients can be discharged safely from the ED.
The goal is to empower patients so they understand their disease and can make the necessary lifestyle changes to control heart failure on their own, going “from coaching them to them becoming their own coaches,” Collins said.
Co-authors from VUMC were Dandan Liu, PhD, Cathy Jenkins, MSc, Alan Storrow, MD, Jin Han, MD, Christina Kampe, MAcc, JoAnn Lindenfeld, MD, Candace McNaughton, MD, PhD, Karen Miller, RN, BSN, Kelly Moser, BA, Russell Rothman, MD, MPH, Wesley Self, MD, MPH, and Michael Ward, MD, PhD.