More than five million Americans of all ages are living with heart failure and 400,000 to 700,000 new cases are diagnosed year. Heart failure is the only major cardiovascular disorder on the rise.

 

In Tennessee, heart disease is the leading cause of death. Heart failure often occurs in the late stages of heart disease when myocardial contraction or filling is significantly impaired and cardiac output is severely diminished. It's a progressive disease that may start slowly in a hypertensive patient or develop rapidly after a heart attack. Untreated heart failure will get worse over time. Heart failure deaths in the United States have doubled since 1979, averaging 250,000 annually.

 

Heart failure is also responsible for more hospitalizations than all forms of cancer combined. The government spends an estimated $12 billion a year on "potentially preventable" re-admissions for Medicare patients, according to the Medicare Payment Advisory Commission. Many of these re-admissions are among the elderly.

 

Treatment of heart failure has evolved over the years. There are new drug combinations, which improve survival, reduce hospitalization as well as slow the disease's progression. Mechanical devices such as pacemaker defibrillators, intra-aortic balloon pumps and left ventricular assist devices can support the failing heart and improve survival. Heart transplantation, which replaces the heart, improves survival and quality of life for a limited number of younger patients with few complicating illnesses. However, much more still needs to be done to treat the millions of patients who have frequent hospitalizations and are not on optimal medical regimens. One of the most important strategies is to actively involve the patient in their treatment. Patients need to be educated about changes in diet, exercise and lifestyle that will improve their quality of life and reduce hospitalizations.

 

Saint Thomas Heart at Baptist and Saint Thomas Hospitals are working with HealthSpring, one of the country's largest Medicare Advantage plans, on a congestive heart failure pilot program. This program is designed to reduce hospital re-admission for class 3 and 4 heart failure patients who are enrolled with HealthSpring and have required hospitalization or emergency room care for heart failure during the past year. The pilot program also aims to improve quality of care and patient satisfaction, promote patient-specific treatment and patient self-management and ensure close collaboration of care between the treatment team, including the cardiologist, office nurse practioner, patient's primary care physician and health plan.

 

Patients in the program have no co-pay for congestive heart failure (CHF) office visits and no limit on the number of office visits. They have access to unlimited transportation to and from the office. Their home care limit and the PCP/specialist referral requirements are eliminated. A dedicated HealthSpring case manager also takes ownership of the patient and manages their socioeconomic issues and other medical conditions.

 

The program allows heart failure program staff the ability to track and monitor patients discharged after hospitalization for heart failure. Patients are referred to the Comprehensive Heart Failure Center at Saint Thomas Heart at Baptist for ongoing care. Nurses provide intensive education and check in with patients, often via telephone, to make sure patients take their medications, monitor their weight and blood pressure, follow diet restrictions and come to appointments. A recent analysis in the New England Journal of Medicine suggested that 52 percent of Medicare patients readmitted within 30 days for heart failure hadn't seen a doctor since discharge. Early preventative measures, such as managing patients through frequent office visits, can avert a lengthy hospitalization requiring a costly stay in the intensive care unit.

 

Since the pilot program began at Baptist Hospital, the readmission rate for patients enrolled in the heart failure program dropped to zero after 30 days and 5 percent after 12 months. Nationally, a patient admitted with CHF has a 30 percent chance of readmission within a month and a greater than 50 percent chance of readmission within six months. Only three patients in the program have been re-admitted to the hospital.

 

In addition to the pilot program, Saint Thomas Heart at Baptist realizes a broad spectrum of services are needed to address CHF and each patient's needs. It's crucial to identify heart failure patients early and for a cardiologist to be involved in their care, particularly for patients with class 2, 3 and 4 CHF. The program also closely collaborates with the practice's cardiac electrophysiologists in order to identify patients who may benefit from implantation of a pacemaker/defibrillator. Such devices not only reduce mortality but may improve quality of life for heart failure patients. Saint Thomas Heart at Baptist cardiologists are also collaborating with primary care physicians to identify patients with frequent admissions in order to enroll them into the Comprehensive Heart Failure Center's programs early. This helps the primary care physician manage these complex and resource intensive patients.

 

The program's impact extends beyond the Nashville metropolitan area. In addition to the many patients who travel from surrounding communities, Saint Thomas Heart was recently awarded a grant to assist rural facilities in expanding their capacity to deliver heart failure treatment. Ultimately, this project aims to provide patients with full access to heart failure treatment and management at their local hospital, rather than traveling up to 200 miles for care.

 

Baptist Hospital continues to strive to implement and improve processes to care for heart failure patients. These processes include following evidence-based practices and guidelines and using a multi-disciplinary team approach. The goal is to ensure appropriate patient and family education so that the whole family can actively participate in a patient's heart failure care. Baptist Hospital recently achieved accreditation as a Heart Failure Institute by the Healthcare Accreditation Colloquium.

 

In order to successfully treat heart failure patients, the country must better manage our health care dollars through more effective systems and partnerships among patients, physicians, hospitals and payers. The pilot program referenced is a wonderful example of how collaboration, close follow-up care and patient education are worth their expense. This program has reduced hospital admissions and health care costs, while simultaneously improving quality of life for many patients affected by heart failure.