• May 2020

    Why every hospital needs to focus on improving heart failure care

With a 46 percent projected increase nationwide in patients living with heart failure between 2014 and 2030, the need to provide effective care for this patient population has taken on new urgency.

According to Shelley Hall, MD, FACC, FACC, FHFSA, FAST, chief of cardiac transplantation, congestive heart failure and mechanical circulatory support at Baylor University Medical Center, part of Baylor Scott & White Health, it’s not only the number of patients, but also the increasing complexity and lifespan of patients with heart failure, that are presenting new challenges. Beyond cardiovascular medicine, these challenges are crossing into nearly all care settings and specialties.

“Our patients are living longer, so they will have more opportunity to be in our emergency rooms,” Dr. Hall says. “These patients come with a bundle of comorbidities – obesity, COPD, diabetes, renal insufficiency – and all of these things exacerbate their condition and vice versa.”

Straining an already overly taxed system

Heart failure patients are major consumers of healthcare resources, and patients with the condition are at high risk of readmission if not properly managed. The average cost of one patient with heart failure visiting the Emergency Department once is more than $1,550, while the cost of a single readmission is nearly $8,000.

Reducing the cost of care for heart failure patients while improving outcomes will require rethinking the value equation and making strategic investments that contribute to heart failure readmission reduction and prevent worsening symptoms.

“We need to get better at managing patients in the outpatient setting to prevent hospitalizations,” says Dr. Hall. “We’ve got to get into preventative mode.”

Dr. Hall advocates for an approach to heart failure that mirrors the approach most physicians now take to proactively managing high blood pressure. Up-titrating heart failure medications is the single most important factor in slowing heart failure disease progression. 

To move toward a preventive model of care and effective management of heart failure on an outpatient basis, Baylor Scott & White Health is focusing on heart failure value metrics and aspects of care that go beyond simple 30-day readmission rates. These include:

  • Reduced overall utilization
  • Earlier identification of complications for more timely referrals
  • Secondary prevention
  • Fewer co-morbidities
  • Better long-term outcomes
  • Improved quality of life

Better management of patients with heart failure requires going beyond the traditional approach to what Dr. Hall calls a “next-gen” approach that expands the vision for heart failure management.

“The approach encompasses total utilization and healthcare expenditure, from diagnosis all the way through the hospitalization,” she says. This includes a 90-day bundle (as opposed to the traditional 30-day discharge bundle) and offering more robust follow-up care. “We have to manage the post-discharge patient better. We have to bring the treatment to the patient.”

The goal is to intervene before a health crisis that leads to a serious and expensive hospitalization. This encompasses a range of initiatives, such as targeting comorbidities and non-clinical needs, as well as tailoring interventions based on patient risk. Collaborating with advanced heart failure programs to maximize therapies early on and better manage outpatients after hospitalization also is essential, as is initiating palliative care discussions sooner than the final days of life.

Dr. Hall believes standardizing care protocols across care settings, providing patients with quality education through multiple channels and looking for efficiencies in all settings along the care continuum is essential for driving better heart failure outcomes both clinically and financially. And being able to measure those outcomes is key.  

“It’s looking at your observed versus expected lengths of stays, all-cause readmission and mortality,” says Dr. Hall, “Those are the three legs of the tripod.” Through a dedicated, programmatic focus on heart failure, Baylor Scott & White is moving the ball forward with overall heart failure results exceeding national averages. As the criteria for success is only going to become more stringent, Baylor Scott & White is dedicated to staying ahead of the curve.