The Three-Phase Terrain of Heart Failure Readmissions
2012; Lippincott Williams & Wilkins; Volume: 5; Issue: 4 Linguagem: Inglês
10.1161/circheartfailure.112.968735
ISSN1941-3297
Autores Tópico(s)Pharmaceutical Practices and Patient Outcomes
ResumoHomeCirculation: Heart FailureVol. 5, No. 4The Three-Phase Terrain of Heart Failure Readmissions Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBThe Three-Phase Terrain of Heart Failure Readmissions Akshay S. Desai, MD, MPH Akshay S. DesaiAkshay S. Desai From the Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. Originally published1 Jul 2012https://doi.org/10.1161/CIRCHEARTFAILURE.112.968735Circulation: Heart Failure. 2012;5:398–400Hospitalization for management of heart failure is a sentinel event with important prognostic implications.1 Despite considerable advances in medical therapy, rates of mortality and readmission after heart failure hospitalization remain high.2 More than half of patients with heart failure are readmitted within 6 months of discharge,3,4 and one in 5 are dead by 1 year.5 The Medicare tab for the roughly one million heart failure hospitalizations annually in the United States alone exceeds $17 billion.6 Readmission rates vary widely among hospitals4 and some have projected that up to three fourths of readmissions may be preventable.7 Policymakers have increasingly targeted reduction in measured readmission rates as a means to simultaneously improve quality of care and reduce costs.Article see p 414Recent legislation and evolving pay-for-performance initiatives have placed particular emphasis on reducing readmissions in the 30-day interval after discharge on the assumption that outcomes in this window can be influenced by greater attention to improving in-hospital heart failure treatment and care transitions. Although easily tracked and intuitively appealing, however, the 30-day metric may be shortsighted. Discharge from a heart failure hospitalization is followed by early readmission in approximately 24% of cases,3 but a minority of rehospitalizations in this window may be truly preventable.7 As well, these early readmissions may be driven more by patient- and community-level factors than care processes under hospital or provider control.4 The apparent inverse relationship between 30-day hospital readmission and mortality rates8 underscores that early readmissions may occasionally reflect enhanced access to hospital care for those with urgent needs rather than poor-quality care.9 Excessive focus on prevention of readmissions at this single time point may have unintended consequences such as competition for the lowest-risk patients or delayed hospitalization of high-risk patients while also stifling the development of a more integrated approach designed for more sustained improvement in patient outcomes.10In this issue of Circulation: Heart Failure, Chun et al11 provide important new data that help to more clearly define the landscape of readmissions beyond the 30-day window. Based on longitudinal follow-up of a cohort of 8543 newly discharged Canadian patients with heart failure, they describe a 3-phase terrain of lifetime risk for readmission after heart failure hospitalization that may have important implications for the design of future prevention strategies. The median survival for the cohort was 1.75 years, and 66.5% of patients were rehospitalized for cardiovascular reasons (predominantly recurrent heart failure) within the first year after discharge. Examining the postdischarge survival duration by deciles, it was noted that approximately 30% of all readmissions occurred within the first 2 months of hospital discharge and 50% occurred within the 2 months before death with much lower admission rates (15%–20%) during the intercurrent "plateau phase" (Figure). At nearly every time point, the proportion of hospitalizations attributed to cardiovascular and noncardiovascular causes was similar. After multivariable adjustment and accounting for repeat hospitalizations, the lifetime readmission risk was indistinguishable for patients with heart failure with reduced versus preserved ejection fraction but was higher for those with ischemic heart disease than for those with nonischemic causes of heart failure.Download figureDownload PowerPointFigure. The 3-phase terrain of readmission risk after heart failure hospitalization. Data adapted from those presented by Chun et al.11These data confirm the hazard for rehospitalization early after discharge and underscore that this vulnerable period does indeed merit attention. Simultaneously, however, they highlight that the real impact on the readmission problem may require a broader focus on approaches to managing the continuing hazard over the lifetime of the disease, including the period just before death. Negotiating the uneven terrain of readmission risk will likely require an adaptive strategy with shifting goals for each phase of illness. Priorities during the heart failure admission should include thorough decongestion and stabilization of fluid balance, identification and management of exacerbating factors, and titration of neurohormonal antagonists for long-term benefit. Once this is accomplished, comprehensive discharge planning, emphasizing patient and caregiver education, medication reconciliation, effective care coordination and use of home nursing supports, and efficient handoffs to intermediate or ambulatory care providers may reduce early readmission rates by as much as 25%.12 Early clinic follow-up (within 1 week of discharge), ideally in collaboration between a primary care physician and cardiovascular specialist, is then critical, because nearly half of heart failure readmissions are reported to occur before the first scheduled ambulatory visit.13,14Although readmission rates do fall with increasing distance from the initial hospitalization, patients with heart failure appear to remain at substantial risk during the "plateau phase," independent of their ejection fraction. In this period, longitudinal disease management focused on maintaining the fluid balance established during the hospitalization and optimizing disease-modifying therapies is likely the primary objective. For patients with heart failure and reduced ejection fraction, the approach to selection of pharmacological and device therapy is informed by data from randomized controlled clinical trials of neurohormonal antagonists, defibrillators, and cardiac resynchronization therapy. Despite comparable risk of recurrent hospitalization, however, there is a paucity of data to guide the selection of treatment for the nearly 50% of those hospitalized with heart failure and preserved ejection fraction who are a growing portion of the heart failure burden. Regardless of ejection fraction, because most heart failure readmissions are related to progressive rise in cardiac filling pressures, effective ambulatory heart failure management must include a strategy for longitudinal surveillance to identify and treat early signs of congestion. Traditional approaches emphasizing intensive surveillance of weight and vital signs have not been consistently effective in reducing readmission rates, but novel approaches emphasizing the use of implantable hemodynamic monitors appear more promising.15Perhaps the most striking observation by Chun et al is the sharp rise in heart failure admissions in the 30 to 60 days before death, which confirms in a community population the experience of a more selected population in transplant centers.16 Although a substantive proportion of readmissions at the beginning of this interval may be unavoidable, there is an urgent need to design an approach to this phase of illness that incorporates acceptable alternatives to hospitalization for those with end-stage disease. Disease management approaches that are effective in preventing rehospitalization earlier in the postdischarge trajectory are often ineffective in the later stages as hypotension, worsening renal function, hemodynamic instability, and diuretic resistance ensue. In this context, a shift in priorities of care may be appropriate for many patients. Frank discussion and acknowledgement of limited prognosis may facilitate discussion of end-of-life preferences and introduction of palliative care approaches focused on symptom management.17 As for patients with terminal cancer, broader use of advanced care planning might enhance overall quality of life and enable some patients and families to avoid the downward spiral of repeat hospitalizations leading up to death.Although an effective 3-phase strategy may help to reduce the burden of preventable cardiovascular hospitalizations, approaches limited to heart failure-specific issues are unlikely to reduce the nearly 50% of rehospitalizations attributable to noncardiovascular causes highlighted in this article and in others.18,19 Simultaneous attention to optimizing the management of comorbid medical illness, including diabetes, anemia, chronic kidney disease, and obesity, is likely equally important to reduction in overall rehospitalization rates. Leveraging team-based healthcare delivery models such as the patient-centered medical home to accomplish this integration may be a critical step toward the reorganization of ambulatory heart failure care.Recent data regarding the lack of impact of pay-for-performance measures on clinical outcomes in heart failure is an important object lesson regarding the limitations of process metrics for gauging the overall quality of care.20 Strategies focused on 30 days in the life of a patient with heart failure will have limited impact on the burden of heart failure either for the nation or the individual. The broader landscape of readmission risk underscores the need for a more comprehensive approach to heart failure management that can efficiently coordinate care to address the peaks of risk in the postdischarge transition and palliative phase while providing longitudinal supports to extend the meaningful journey that stretches between.DiscussionNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Akshay S. Desai, MD, Cardiovascular Division, PBB-A3-AB370, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail [email protected].References1. Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure.Circulation. 2007; 116:1482–1487.LinkGoogle Scholar2. Jhund PS, Macintyre K, Simpson CR, Lewsey JD, Stewart S, Redpath A, Chalmers JW, Capewell S, McMurray JJ. Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people.Circulation. 2009; 119:515–523.LinkGoogle Scholar3. Krumholz HM, Merrill AR, Schone EM, Schreiner GC, Chen J, Bradley EH, Wang Y, Wang Y, Lin Z, Straube BM, Rapp MT, Normand SL, Drye EE. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission.Circ Cardiovasc Qual Outcomes. 2009; 2:407–413.LinkGoogle Scholar4. Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives.Circ Cardiovasc Qual Outcomes. 2011; 4:53–59.LinkGoogle Scholar5. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study.N Engl J Med. 2006; 355:260–269.CrossrefMedlineGoogle Scholar6. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O'Donnell C, Roger V, Sorlie P, Steinberger J, Thom T, Wilson M, Hong Y. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation. 2008; 117:e25–146.LinkGoogle Scholar7. van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review.CMAJ. 2011; 183:E391–402.CrossrefMedlineGoogle Scholar8. Heidenreich PA, Sahay A, Kapoor JR, Pham MX, Massie B. Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006.J Am Coll Cardiol. 2010; 56:362-368.CrossrefMedlineGoogle Scholar9. van Walraven C, Jennings A, Taljaard M, Dhalla I, English S, Mulpuru S, Blecker S, Forster AJ. Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions.CMAJ. 2011; 183:E1067–1072.CrossrefMedlineGoogle Scholar10. Joynt KE, Jha AK. Thirty-day readmissions—truth and consequences.N Engl J Med. 2012; 366:1366–1369.CrossrefMedlineGoogle Scholar11. Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure.Circ Heart Fail.2012; 5:414–421.LinkGoogle Scholar12. Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis.JAMA. 2004; 291:1358–1367.CrossrefMedlineGoogle Scholar13. Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW, Peterson ED, Curtis LH. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.JAMA. 2010; 303:1716–1722.CrossrefMedlineGoogle Scholar14. Lee DS, Stukel TA, Austin PC, Alter DA, Schull MJ, You JJ, Chong A, Henry D, Tu JV. Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department.Circulation. 2010; 122:1806–1814.LinkGoogle Scholar15. Desai AS. Home monitoring heart failure care does not improve patient outcomes: looking beyond telephone based disease management.Circulation. 2012; 125:828–836.LinkGoogle Scholar16. Russo MJ, Gelijns AC, Stevenson LW, Sampat B, Aaronson KD, Renlund DG, Ascheim DD, Hong KN, Oz MC, Moskowitz AJ, Rose EA, Miller LW. The cost of medical management in advanced heart failure during the final two years of life.J Card Fail. 2008; 14:651–658.CrossrefMedlineGoogle Scholar17. Allen LA, Stevenson LW, Grady KL, Goldstein NE, Matlock DD, Arnold RM, Cook NR, Felker GM, Francis GS, Hauptman PJ, Havranek EP, Krumholz HM, Mancini D, Riegel B, Spertus JA. Decision making in advanced heart failure: a scientific statement from the American Heart Association.Circulation. 2012; 125:1928–1952.LinkGoogle Scholar18. Dunlay SM, Redfield MM, Weston SA, Therneau TM, Hall Long K, Shah ND, Roger VL. Hospitalizations after heart failure diagnosis a community perspective.J Am Coll Cardiol. 2009; 54:1695–1702.CrossrefMedlineGoogle Scholar19. Angermann CE, Stork S, Gelbrich G, Faller H, Jahns R, Frantz S, Loeffler M, Ertl G. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study.Circ Heart Fail.2012; 5:25–35.LinkGoogle Scholar20. Jha AK, Joynt KE, Orav EJ, Epstein AM. The long-term effect of premier pay for performance on patient outcomes.N Engl J Med. 2012; 366:1606–1615.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro M, Delgado J, Díez J, Formiga F and Manito N (2021) Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2021.754499, 8 Kinugasa Y, Saitoh M, Ikegame T, Ikarashi A, Kadota K, Kamiya K, Kohsaka S, Mizuno A, Miyajima I, Nakane E, Nei A, Shibata T, Yokoyama H, Yumikura S, Yumino D, Watanabe N and Isobe M (2021) Differences in Priorities for Heart Failure Management Between Cardiologists and General Practitioners in Japan, Circulation Journal, 10.1253/circj.CJ-21-0335, 85:9, (1565-1574), Online publication date: 25-Aug-2021. Lee J, Hung C, Huang C, Chen Y, Wu H, Chuang P, Yu J and Ho Y (2021) The Costs and Cardiovascular Benefits in Patients With Peripheral Artery Disease From a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study, Journal of Medical Internet Research, 10.2196/24346, 23:5, (e24346) Boodoo C, Zhang Q, Ross H, Alba A, Laporte A and Seto E (2020) Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis, Journal of Medical Internet Research, 10.2196/18917, 22:10, (e18917) Driscoll A, Dinh D, Prior D, Kaye D, Hare D, Neil C, Lockwood S, Brennan A, Lefkovits J, Carruthers H, Amerena J, Cooke J, Vaddadi G, Nadurata V and Reid C (2020) The Effect of Transitional Care on 30-Day Outcomes in Patients Hospitalised With Acute Heart Failure, Heart, Lung and Circulation, 10.1016/j.hlc.2020.03.004, 29:9, (1347-1355), Online publication date: 1-Sep-2020. Kitakata H, Kohno T, Kohsaka S, Shiraishi Y, Parizo J, Niimi N, Goda A, Nishihata Y, Heidenreich P and Yoshikawa T (2020) Prognostic Implications of Early and Midrange Readmissions After Acute Heart Failure Hospitalizations: A Report From a Japanese Multicenter Registry, Journal of the American Heart Association, 9:10, Online publication date: 18-May-2020. Ly H, Noly P, Nosair M and Lamarche Y (2020) When the Complex Meets the High-Risk: Mechanical Cardiac Support Devices and Percutaneous Coronary Interventions in Severe Coronary Artery Disease, Canadian Journal of Cardiology, 10.1016/j.cjca.2019.12.001, 36:2, (270-279), Online publication date: 1-Feb-2020. Ishihara S, Kawakami R, Nogi M, Hirai K, Hashimoto Y, Nakada Y, Nakagawa H, Ueda T, Nishida T, Onoue K, Soeda T, Okayama S, Watanabe M and Saito Y (2020) Incidence and Clinical Significance of 30-Day and 90-Day Rehospitalization for Heart Failure Among Patients With Acute Decompensated Heart Failure in Japan ― From the NARA-HF Study ―, Circulation Journal, 10.1253/circj.CJ-19-0620, 84:2, (194-202), Online publication date: 24-Jan-2020. Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez J, Abellán-Pérez M, Hernández-Vicente Á and Pascual-Figal D (2019) Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia, Revista Española de Cardiología, 10.1016/j.recesp.2018.05.037, 72:9, (740-748), Online publication date: 1-Sep-2019. Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez J, Abellán-Pérez M, Hernández-Vicente Á and Pascual-Figal D (2019) Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2018.08.014, 72:9, (740-748), Online publication date: 1-Sep-2019. Wachter R, Senni M, Belohlavek J, Straburzynska‐Migaj E, Witte K, Kobalava Z, Fonseca C, Goncalvesova E, Cavusoglu Y, Fernandez A, Chaaban S, Bøhmer E, Pouleur A, Mueller C, Tribouilloy C, Lonn E, A.L. Buraiki J, Gniot J, Mozheiko M, Lelonek M, Noè A, Schwende H, Bao W, Butylin D, Pascual‐Figal D, Gniot J, Mozheiko M, Lelonek M, Dominguez A, Horacek T, del Rio E, Kobalava Z, Mueller C, Cavusoglu Y, Straburzynska-Migaj E, Slanina M, vom Dahl J, Senni M, Ryding A, Moriarty A, Robles M, Villota J, Quintana A, Nitschke T, Manuel Garcia Pinilla J, Bonet L, Chaaban S, Filali zaatari, MD S, Spinar J, Musial W, Abdelbaki K, Belohlavek J, Fehske W, Bott M, Hoegalmen G, Leiro M, Ozcan I, Mullens W, Kryza R, Al-Ani R, Loboz-Grudzien K, Ermoshkina L, Hojerova S, Fernandez A, Spinarova L, Lapp H, Bulut E, Almeida F, Vishnevsky A, Belicova M, Pascual D, Witte K, Wong K, Droogne W, Delforge M, Peterka M, Olbrich H, Carugo S, Nessler J, McGill T, Huegl B, Akin I, Moreira I, Baglikov A, Thambyrajah J, Hayes C, Barrionuevo M, Yigit Z, Kaya H, Klimsa Z, Radvan M, Kadel C, Landmesser U, Di Tano G, Lisik M, Fonseca C, Oliveira L, Marques I, Santos L, Lenner E, Letavay P, Bueno M, Mota P, Wong A, Bailey K, Foley P, Hasbani E, Virani S, Massih T, Al‐Saif S, Taborsky M, Kaislerova M, Motovska Z, Praha , Cohen A, Logeart D, Endemann D, Ferreira D, Brito D, Kycina P, Bollano E, Basilio E, Rubio L, Aguado M, Schiavi L, Zivano D, Lonn E, Sayed A, Pouleur A, Heyse A, Schee A, Polasek R, Houra M, Tribouilloy C, Seronde M, Galinier M, Noutsias M, Schwimmbeck P, Voigt I, Westermann D, Pulignano G, Vegsundvaag J, Alexandre Da Silva Antunes J, Monteiro P, Stevlik J, Goncalvesova E, Hulkoova B, Juan Castro Fernandez A, Davies C, Squire I, Meyer P, Sheppard R, Sahin T, Sochor K, De Geeter G, Wachter R, Schmeisser A, Weil J, Soares A, Vasilevna O, Oshurkov A, Sunderland S, Glover J, Exequiel T, Decoulx E, Meyer S, Muenzel T, Frioes F, Arbolishvili G, Tokarcikova A, Karlstrom P, Carles Trullas Vila J, Perez G, Sankaranarayanan R, Nageh T, Alasia D, Refaat M, Demirkan B, Al-Buraiki J and Karabsheh S (2019) Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study, European Journal of Heart Failure, 10.1002/ejhf.1498, 21:8, (998-1007), Online publication date: 1-Aug-2019. Albert C and Estep J (2019) Economic Impact of Chronic Heart Failure Management in Today's Cost-Conscious Environment, Cardiac Electrophysiology Clinics, 10.1016/j.ccep.2018.11.002, 11:1, (1-9), Online publication date: 1-Mar-2019. Gonçalvesová E and Danková M (2018) What we know about epidemiology of heart failure in Slovakia and globally, Vnitřní lékařství, 10.36290/vnl.2018.115, 64:9, (839-846), Online publication date: 1-Sep-2018. Ammenwerth E, Modre-Osprian R, Fetz B, Gstrein S, Krestan S, Dörler J, Kastner P, Welte S, Rissbacher C and Pölzl G (2018) HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care, JMIR Cardio, 10.2196/cardio.9936, 2:1, (e11) Hung C, Lee J, Chen Y, Huang C, Wu V, Wu H, Chuang P and Ho Y (2018) Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study, Journal of Medical Internet Research, 10.2196/jmir.8914, 20:1, (e23) Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick T and Hare D (2018) Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age, Clinical Medicine Insights: Cardiology, 10.1177/1179546818809358, 12, (117954681880935), Online publication date: 1-Jan-2018. Sukul D, Sinha S, Ryan A, Sjoding M, Hummel S and Nallamothu B (2017) Patterns of Readmissions for Three Common Conditions Among Younger US Adults, The American Journal of Medicine, 10.1016/j.amjmed.2017.05.025, 130:10, (1220.e1-1220.e16), Online publication date: 1-Oct-2017. Delgado J, Oliva F and Reinecke A (2017) The inodilator levosimendan in repetitive doses in the treatment of advanced heart failure, European Heart Journal Supplements, 10.1093/eurheartj/sux004, 19:suppl_C, (C8-C14), Online publication date: 9-Mar-2017. Riley J and Masters J (2016) Practical multidisciplinary approaches to heart failure management for improved patient outcome, European Heart Journal Supplements, 10.1093/eurheartj/suw046, 18:suppl G, (G43-G52), Online publication date: 1-Nov-2016. Inamdar A and Inamdar A (2016) Heart Failure: Diagnosis, Management and Utilization, Journal of Clinical Medicine, 10.3390/jcm5070062, 5:7, (62) Sangaralingham L, Shah N, Yao X, Roger V and Dunlay S (2016) Incidence and Early Outcomes of Heart Failure in Commercially Insured and Medicare Advantage Patients, 2006 to 2014, Circulation: Cardiovascular Quality and Outcomes, 9:3, (332-337), Online publication date: 1-May-2016. Freedland K, Carney R, Rich M, Steinmeyer B, Skala J and Dávila-Román V (2016) Depression and Multiple Rehospitalizations in Patients With Heart Failure, Clinical Cardiology, 10.1002/clc.22520, 39:5, (257-262), Online publication date: 1-May-2016. Hadi A, Hellman Y, Malik A, Caccamo M, Gradus-Pizlo I and Kingery J (2014) Reducing Heart Failure Readmission Rates with an Emergency Department Early Readmission Alert, The American Journal of Medicine, 10.1016/j.amjmed.2014.07.025, 127:11, (1060-1062), Online publication date: 1-Nov-2014. Lee D and Ezekowitz J (2014) Risk Stratification in Acute Heart Failure, Canadian Journal of Cardiology, 10.1016/j.cjca.2014.01.001, 30:3, (312-319), Online publication date: 1-Mar-2014. Sales V, Ashraf M, Lella L, Huang J, Bhumireddy G, Lefkowitz L, Feinstein M, Kamal M, Caesar R, Cusick E, Norenberg J, Lee J, Brener S, Sacchi T and Heitner J (2013) Utilization of Trained Volunteers Decreases 30-Day Readmissions for Heart Failure, Journal of Cardiac Failure, 10.1016/j.cardfail.2013.10.008, 19:12, (842-850), Online publication date: 1-Dec-2013. July 2012Vol 5, Issue 4 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.112.968735PMID: 22811548 Originally publishedJuly 1, 2012 Keywordsheart failurehospitalizationEditorialhospital readmission follow-up studiesPDF download Advertisement SubjectsCongenital Heart DiseaseEthics and Policy
Referência(s)