Hear failures (HF) that are often referred to as congestive heart failures (CHF) are one of the most persistent causes of readmissions. As stated by Feltner et al. (2014), readmissions within thirty days occur for almost 25% of patients that were hospitalized with heart failure. Currently, medical science and the community are in search of a solution to this problem. There is a debate on which means are better suited to prevent readmissions, and what actions must be taken to implement them in the best possible way. Also, the situation is worsened by the fact that most patients hospitalized with heart failure are older and possess a naturally higher risk of readmission. Therefore, it is up to researchers to find the solution and offer ways to implement it. This paper will provide an overview of the prevailing theories addressing readmission reduction theories. The theories will be compared and researched more thoroughly in the second part of the paper.
Prevailing Theories and Findings
The first theory that is the focus of this paper is already mentioned. This theory is offered by Feltner et al. (2014) and suggests that interventions in transitional care may substantially reduce readmission rates for patients with heart failures. To test their suggestions, the authors carry out forty-seven trials. The patients enrolled in the trials have had moderate to severe cases of heart failure, the mean age is seventy years. The authors conclude that “Home-visiting programs and MDS-HF clinics reduced all-cause readmission and mortality; STS reduced HF-specific readmission and mortality” (Feltner et al., 2014, p. 774). It is further noted that such interventions must be significantly focused on by organizations and leaderships that seek to implement interventions in transitional care for patients that experienced heart failures.
Further, research by Dharmarajan et al. (2013) focuses on understanding rather than forming a separate theory of decreasing heart failure readmission rates. However, the authors theorize that the current amount of knowledge regarding causes of thirty-day readmissions due to heart failures is insufficient and requires significant expansion and additional studies. To better cover the topic, the authors measured readmission volumes in the specific period (from 2007 to 2009). The results demonstrate that more than three hundred twenty thousand thirty-day readmissions out of almost one and a half million heart failure hospitalizations. This displays that nearly 25% of patients had heart failures requiring readmission after hospital discharge.
This research indeed showcases that the current understanding of the causes of readmissions is indeed insufficient. The authors conclude that “30-day readmissions were frequent throughout the month after hospitalization and resulted from a similar spectrum of readmission diagnoses regardless of age, sex, race, or the time after discharge” (Dharmarajan et al., 2013, p. 355). Therefore, it is unclear as to what exactly causes readmissions and what actions must be taken before or after readmissions not to allow additional complications.
Another research performed by Gheorghiade et al. (2013) theorizes that adding aliskiren (a direct renin inhibitor) would reduce mortality in patients with heart failures and readmission rates for such cases. To test their theory, the authors implemented an “International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission” (Gheorghiade et al., 2013, p. 1125). The patients that enrolled for this testing received 150 mg of aliskiren, while some patients received up to 300 mg depending on their tolerance levels. All of the patients were diagnosed with left ventricular ejection fraction (LVEF). The results of the study were not successful as mortality and readmission rates did not reduce in patients with LVEF. It is possible, however, that other types of heart failures may react differently to aliskiren resulting in lesser mortality and readmission rates. The authors do not state if this is possible or if they will conduct further researches for other diseases.
Bradley et al. (2013) conduct research designed to determine a set of strategies that would reduce readmission rates for patients with heart failures. More specifically, the authors focus on thirty-day readmissions. The authors state that readmission rates reduction is a priority on a national level. Nevertheless, evidence related to the reduction of readmission rates is scarce and insufficient. Thus, the authors researched medical evidence gathered from hospitals that participated in the national readmission reduction initiative from 2010 to 2011. As a result, it was determined that there are several strategies associated with lower rates of readmissions for patients that experienced heart failures.
There are six strategies that the authors were able to mark as reducing readmission rates. These strategies are “partnering with community physicians or physician groups to reduce readmission, … partnering with local hospitals to reduce readmissions, … having nurses responsible for medication reconciliation, … arranging follow-up appointments before discharge, … having a process in place to send all discharge paper or electronic summaries directly to the patient’s primary physician, … and assigning staff to follow up on test results that return after the patient is discharged” (Bradley et al., 2013, p. 444). Each strategy was evaluated based on how much readmission rates decreased with its implementation. As it becomes evident, this research resulted in some significant findings that may significantly improve the health care system in general as well as decrease readmission rates.
Finally, Calvillo-King et al. (2013) discuss the importance of social factors regarding readmission rates. The authors based their research on various publications covering the topic from 1980 to 2012. In a conclusion, the authors were able to gather seventy-two articles that related to the topic. A significant amount of social factors were determined as important in influencing readmission rates. Such factors as age, gender, race, education, income, insurance, and many others are included in the final table of related social characteristics. The authors note that “future research on adverse events after discharge should study social determinants of health” (Calvillo-King et al., 2013, p. 269).
Theories and Findings Comparison
The most significant evidence provided amongst the mentioned sources is probably the work by Feltner et al. (2014). This research is important due to several reasons. First, it is a relatively recent publication that allows research consumers to consider it more relevant and, therefore, precise. Second, during the practical part of the research, the authors achieved excellent results. Third, all of these reasons combined make this research very important in terms of reducing readmission rates amongst patients with heart failures. It is safe to assume that this research will find broad implementation in medical practice.
Research by Gheorghiade et al. (2013) is more of an example of less relevant studies. Although the work performed by the authors is tremendous, to say the least, the most important part of any research is the achievement of certain results. This research did not achieve much. However, this research proved that aliskiren distribution for patients with heart failures does not reduce mortality or readmissions. Although relatively small, this evidence is also important for medical science and practice.
Other researches mentioned in this paper provide various pieces of data regarding different topics. However, each of them is equally important for decreasing readmission rates. All in all, it is evident that there are numerous other researches that dwell on very different topics. However, each of them has the potential to drastically increase the amount of knowledge regarding readmission rates in patients with heart failures. As of now, literature covering readmissions is great in volumes and provides evidence that supports various theories or dismisses them. With the increase in publications, the nature of readmission causes becomes much clearer.
Conclusion
Although readmission rates in patients with heart failures significantly lack evidence, current researches, as well as those performed in recent years, tend to eliminate this gap quickly. It becomes evident that not only direct treatment of heart failures is required to reduce readmissions. A set of various factors that influence readmission rates as well as procedures aimed at eliminating them is now known to medical science. If each aspect mentioned in various publications receives enough attention, nurses and physicians will be able to reduce readmissions for patients with heart failures almost to the point of non-existence. However, the factors contributing to possible readmissions are rather high in numbers, and it becomes significantly hard to take them all into account. Moreover, a such number of different variables ensures that there is always a risk regardless of how safe any given treatment is. It is up to medical science specialists to find solutions to all of these problems.
References
Bradley, E. H., Curry, L., Horwitz, L. I., Sipsma, H., Wang, Y., Norine, M., … Krumholz, H. M. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes, 6(1), 444-450.
Calvillo-King, L., Arnold, D., Eubank, K. J., Lo, M., Yunyongying, P., Stieglitz, H., … Halm, E. A. (2013). Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: Systematic review. Journal of General Internal Medicine, 28(2), 269-282.
Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I., … Krumholz, H. M. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA, 309(4), 355-363.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E. J. L., … Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Annals of Internal Medicine, 160(1), 774-784.
Gheorghiade, M., Bhöm, M., Greene, S. J., Fonarow, G. C., Lewis, E. F., Zannad, F., … Maggioni, A. P. (2013). Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure. JAMA, 309(11), 1125-1135.