- About 73% of people with heart failure will live for five years and almost 35% will live for 10 years.
- Between 20% to 25% of people with heart failure will be re-hospitalized within 60 days.
- Researchers from the Smidt Heart Institute at Cedars-Sinai found more follow-up phone calls after hospitalization may help people with heart failure live longer and not be re-hospitalized as frequently.
More than 26 million people around the world experience heart failure.
Also known as congestive heart failure, this type of cardiovascular disease occurs when the heart is not able to efficiently pump blood throughout the body.
There is currently no cure for heart failure.
Previous research shows 20% to 25% of people with heart failure discharged from the hospital are readmitted within 60 days.
About 73% of people with heart failure will live five years and almost 35% for 10 years.
Now, researchers from the Smidt Heart Institute at Cedars-Sinai in Los Angeles are reporting heart failure patients who received a post-hospitalization care plan, including more follow-up phone calls from nurses, stayed out of the hospital longer than those who received the usual follow-up plan of only one follow-up phone call.
The team found people with heart failure alongside other diseases who received the additional phone calls spent less time in the hospital and were less likely to die during the study period compared to the group receiving the standard follow-up.
The study was recently published in the Journal of Cardiac Failure.
What is heart failure?
Heart failure happens when the heart is no longer able to pump blood throughout the body.
This damage to the heart can occur for different reasons, including:
- high blood pressure
- heart inflammation
- coronary heart disease
- congenital heart defects
- family history/genetics
Symptoms of heart failure include:
- fluid around the lungs
- shortness of breath
- fluid retention throughout the body
- tiredness and/or dizziness
- irregular and/or rapid heartbeat
Current treatments for heart failure include medications and surgical options.
Clues from another study
According to Dr. Ilan Kedan, a professor of cardiology at the Smidt Heart Institute at Cedars-Sinai and corresponding author of the study, he and his team decided to study a new way to improve survival outcomes for people with heart failure after reviewing results from the BEAT-HF clinical trial.
“It was noted that there was an improvement in quality of life scores in the intervention group — those patients receiving telemonitoring and nurse coaching — without showing a significant effect on the primary outcome of 180-day all-cause readmission,” Kedan explained to Medical News Today. “Although quality of life was not the primary measure of the study, it is a meaningful measure of quality of care, especially in heart failure patients that are sick enough to be hospitalized.”
Kedan said they decided that looking more closely at the enrolled patient population may help identify subgroups that may have benefitted from the intervention.
“Our initial hypothesis was that some patients who were less sick may not receive meaningful benefit from an additional resource intervention,” he said. “Additionally, we hypothesized that the sickest patients with the greatest number of co-morbidities would also be less likely to benefit from telemonitoring and nurse coaching.”
“Additionally, the value of identifying more specific uses for a lower cost and more accessible intervention like telephone nurse coaching and telemonitoring of weight, blood pressure, heart rate, and symptoms was compelling in its own right,” Kedan added. “When there (have) been more trends to develop novel technology for acquiring and assessing biometric data from home, a low tech old-fashioned phone call was worth evaluating as well.”
Helping lower readmissions
Dr. Yu-Ming Ni, a cardiologist of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California and one of the authors of this study, said they also decided to look at ways to improve survival outcomes for people with heart failure because there is always a push to improve outcomes.
“We know heart failure is an extremely high-burden disease — it puts a lot of pressure on patients,” he told Medical News Today. “They get in the hospital and there’s a lot of changes that occur when someone is in heart failure that makes them vulnerable to be readmitted to the hospital again.”
“And so one of the reasons that we’re doing this is because hospital readmissions for heart failure are always high — they’re always an issue,” Ni continued. “It’s detrimental (to) the patient’s quality of life. And so one of the things that we’re trying to do is to determine if there is something that can really improve the likelihood that someone’s going to be able to stay at home and be functional and not end up back in the hospital again. So that’s one of the reasons for the emphasis of this study.”
Heart failure follow-up
In this study, Kedan, Ni, and their team evaluated more than 1,300 people who were 50 years old and older who had been hospitalized for heart failure.
Half of the study participants received a revised post-hospitalization care plan. The plan included pre-discharge heart failure education and an average of five follow-up phone calls from nurses over 180 days.
Additionally, each participant received a blood pressure monitor and scale to provide their weight, blood pressure, and heart rate during the phone calls. Anyone who reported unusual symptoms received additional follow-up calls.
The other half of the study participants received the standard follow-up care including pre-discharge heart failure education and one follow-up phone call from the hospital.
People in the study were also grouped by how many other diseases or health conditions they had in addition to heart failure, resulting in high, moderate, and low comorbidity groups.
Upon analysis, the researchers reported that study participants in the high comorbidity group who received the new follow-up procedure were 25% less likely to die at 30 days and over 50% less likely to die at 180 days than those in the group who received the standard follow-up.
Additionally, they stayed out of the hospital for an average of 152 days, compared to 133 days for the people who did not receive the new follow-up procedure.
Researchers reported people in the low and moderate comorbidity groups who received the new protocol did not have any statistically significant different outcomes from those who received the standard follow-up.
Analyzing the results
Kedan said these findings provide many implications for medical professionals in improving follow-up care for people with heart failure.
“First, having nurses call patients to check on their symptoms and help with their care over the telephone both kept the sickest patients alive longer and also kept these same patients out of the hospital on average 19 fewer days over the 180 measurement period,” he said. “Nurse telemonitoring can often be employed with existing resources in the clinical setting. With a purpose of alleviating suffering in heart failure patients, this measured effect of nurse coaching is beyond impactful.”
“For patients that are unable to tolerate escalation of guideline-directed medical therapy or ones that can tolerate very few medications, a nurse telemonitoring ‘treatment’ program can be a meaningful addition to potentially engage patients and their caregivers in alleviating the morbidity associated with severe heart failure,” Kedan added.
Research next steps
As for the next steps in this research, Ni said the first will be fine-tuning their post-hospitalization intervention for it to be more applicable to all patients in medical centers across the country.
“And then the second thing is we’ve identified a target population that benefits from this intervention — patients with high comorbidity,” he continued. “Do we need to be more specific about what patient group would benefit or is this going to work with this comorbidity score?”
“There’s more work to be done here,” Ni added. “My hope is that we can implement this across the country and really help people to stay at home after they’re hospitalized for heart failure.”
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