Heart Failure Management Program Works Better at Home

Physician Bulletins: Below, you will find a sample of the community-based healthcare utilization bulletins that we routinely mail to referring doctors and other healthcare professionals.

The American Heart Association and other authoritative bodies have long considered management programs for congestive heart failure (CHF) part of gold-standard care.^1,2 Research demonstrates how chronic heart failure management programs create significant reductions in all-cause readmissions and prolong survival.³ However, the composition of these programs varies widely and this includes the settings (rehab facilities, outpatient, home face-to-face, and home via remote communication). Julie Sochalski presents compelling data suggesting heart failure management programs should be delivered face-to-face.⁴ Additionally, Dr. Simon Stewart recently published an important, head-to-head comparison of the same program delivered at home and delivered in an outpatient setting. ⁵

In Stewart’s study, a nurse-led CHF management program was added to usual care from each patient’s cardiologist and pri-mary care practitioner. The average patient was 71 years old. One group received the management program via home visits. The other group traveled to a clinic for the program. The setting was the primary difference between the experimental groups. At both short and long-term follow-up, the home group showed fewer hospitalization days and lower healthcare costs. At four-year follow-up, compared to the same program delivered via outpatient care, the home-based management program saw a 31% lower mortality rate and 30% fewer hospitalization days. When other variables are equal, the home proves an advantageous setting for heart failure management. At least some portion of heart failure management programs should be delivered at home.

The greater effects achieved by home nursing versus clinic-based nursing may stem from multiple comparative advantages. Elderly patients prove more adherent to home-based care plans. In Stewart’s study, the home-based group attended their management visits more than the clinic-based group by 17%. The CHF management plan included medication reconciliation, which is a specific activity that can be more accurate when performed at home. For instance, in Dr. Linda Costa’s study, patients received medication reconciliation predischarge, then by phone after discharge, and finally at home after discharge. The in-home medication review discovered 62% more medication discrepancies that went undetected in other settings.⁶ Finally, Stewart’s CHF management plan included diet teaching and family caregiver training. For both services, greater access to the home environment can lead to more discovery and more access to family caregivers.

Despite recommendations for CHF management plans and their known benefits, real-world implementation of management plans may be as low as 20% of eligible patients, with participation rates even lower among patients of advanced age.4 Bar-riers to this care include cost, patient enthusiasm, transportation barriers, and the medical community not knowing where to refer. One referral to Avatar Home Health can overcome all these barriers. Please refer patients with CHF to Avatar Home Health.

Leading Texas in Preventing Urgent Care

Medicare data shows that, compared to other agencies in Texas, the patients you refer to Avatar prove 35% less likely to need urgent / ER care during the home health episode. We attribute this success to our 24/7 nurse-on-call and to quality care that helps patients manage their conditions better.

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1. Krum H, Jelinek M, Steward S, et al. Guidelines for the prevention, detection and man-agement of people with chronic heart failure in Australia. Med J Aust. 2006; 185: 549-57.
2. Jessup M, Abraham W, Casey D, et al. ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circu-lation. 2009; 119: 1977-2016.
3. Stewart S, Marley J, Horrowitz J. Effects of a multidisciplinary, home-based interven-tion on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet. 1999; 354: 1077-83.
4. Sochalski J, Jaarsma T, Krumholz H, et al. What works in chronic care management: the case of heart failure. Health Aff (Millwood). 2009; 28: 179-89.
5. Stewart S, Carrington M, Horowitz J, et al. Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multice-tre randomized trial cohort. Journal of the American College of Cardiology. 2014; 174: 600-610.
6. Costa L, Poe S. Challenges in posthospital care: nurses as coaches for medication management. J Nurs Care Qual. 2011; 26 (3): 243-251.
7. Ades P, Keteyian S, Wright J, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clinic Proceedings. 2016 Nov 15; Elsevier.