Issue link: https://viewer.e-digitaledition.com/i/635202
A PUBLIC HEALTH QUANDARY THE NUMBER OF A merica ns living with HF is approaching 6²million, with approximately 670,000 new cases diagnosed annua lly, according to the A merican Heart Association. It is the leading cause of hospita lization — accounting for about 1² mi l lion admissions each yea r — a nd rehospita lization among Medicare benef iciaries. The complexity, f luidity and highly individua lized nature of HF ca re ma ke it notoriously diff icult to ma nage, according to one exper t. "HF severe enough to require hospita lization, particularly more tha n once, is adva nced disease," says Lynne Wa rner Stevenson, M D, Director of t he Hea r t Fa i lure Prog ra m a nd² P rofessor of Med ici ne at t he Cent er for Adva nced Hea r t Disease in the Hea r t a nd Vascula r Center at Brigha m a nd² Women's Hospita l in Boston. " It is a hig her level of disea se tha n most of our therapies have been developed to treat. "Heart failure is a dynamic disease that changes from day to day, so changes in daily sa lt and fl uid inta ke, food inta ke, exercise, and other activities change the patient's physiolog y such that the 'right ' doses of medications, particularly the medications that help prevent or treat fl uid retention, diƒ er from day to day," Dr. Stevenson continues. "Care needs to be individua lized for each patient, as there are few 'average' patients who do best on 'average' doses of medication. We have been trying to [manage HF] with a one-size-fi ts-all approach to the medication regimen." Hospitals have been incentivized to reduce HF readmissions since Medicare's implementation of pena lties for excessive rehospita lizations in 2012, but the task remains daunting. "Data show that about one in four HF patients is readmitted by the 30-day mark and one in two by the six-month mark," says A kshay Suva s Desa i, MD, MPH, Director of Hea r t Failure Disease Management in the Advanced Heart Disease A GROUP OF NURSES AND CLINICIANS AT THE UNIVERSIT Y OF CALIFORNIA, SAN FR ANCISCO ¤UCSF¥ HAVE CRE ATED A STR ATEGY THAT HOSPITALS MAY BE ABLE TO APPLY TOWARD SOLVING ONE OF HE ALTH CARE'S MOST SERIOUS AND COSTLY ISSUES: HE ART FAILURE ¤HF¥ REHOSPITALIZ ATION. for Reducing Heart Failure Readmissions A TEACHable Tool BY THOMAS CROCKER SPECIAL CLINICAL SECTION: CARDIOLOGY 1 8