Transcript Vulnerable phase post-discharge

Post-discharge is a vulnerable phase
for heart failure patients
“Hospitalized heart failure is associated with unacceptable
high post-discharge mortality and rehospitalization rate”1
 Several recent publications1-5 discuss important issues on hospitalized heart failure
patients who have unacceptably high post-discharge mortality and rehospitalization
rates. A high event rate despite all available therapies makes this topic a health care
priority in terms of patient well-being and expenditure.
 With the aging of the population and an ever-increasing burden of disease, the
cumulative incidence and prevalence of heart failure requiring hospitalization have
evolved into epidemic proportions. The costs associated with hospitalized heart failure
have added demands from society, government, and payers to improve outcomes.
REFERENCES---------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ---------------------1-Gheorghiade M, Shah AN, Vaduganathan M, et al. Recognizing hospitalized heart failure as an entity and developing new therapies to improve outcomes academics’, clinicians’, industry’s, regulators’, and
payers’ perspectives. Heart Failure Clin. 2013;9:285-290.
2-Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes. 2011;4:53-59.
3-Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. May 2, 2012. doi 10.1161/
CIRCHEARTFAILURE.111.964791. http://circheartfailure.ahajournals.org. Accessed April 19, 2012.
4-Krumholz HM. Post-hospital syndrome – an acquired, transient condition of generalized risk. N Engl J Med. 2013;368;100-102.
5-Marti CN, Fonarow GC, Gheorghiade M, Butler J. Timing and duration of interventions in clinical trials for patients with hospitalized heart failure. Circ Heart Fail. 2013;6:1095-1101.
Mortality is particularly high in the early phase after
hospitalization
All-cause mortality after discharge for HF is high at the 1st month 1
Changes in risk profile after hospitalization. Hasard ratio of all-cause mortality after discharge from hospital for first hospitalization for heart failure
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1-Marti NC, Fonarow GC, Gheorghiade M, Bulter J. Timing and duration of interventions in clinical trials for patients with hospitalized heart failure. Circ Heart Fail 2013;6:1095-1101
Rehospitalization is particularly high in the early phase after
hospitalization1
30 days from discharge
1 patient out of 4 is readmitted
6 months from discharge
1-2
1 patient out of 2 is readmitted
3-4
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------1-Gheorghiade M, Shah AN, Vaduganathan M, et al. Recognizing hospitalized heart failure as an entity and developing new therapies to improve outcomes academics’, clinicians’, industry’s, regulators’, and
payers’ perspectives. Heart Failure Clin. 2013;9:285-290.
2-Marti NC, Fonarow GC, Gheorghiade M, Butler J. Timing and duration of interventions in clinical trials for patients with hospitalized heart failure. Circ Heart Fail. 2013;6:1095-1101.
3-Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes. 2011;4:53-59.
4-Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. May 2, 2012. doi 10.1161/
CIRCHEARTFAILURE.111.964791. http://circheartfailure.ahajournals.org. Accessed April 19, 2012.
Weeks to months post-discharge at high risk may be viewed
as a “vulnerable phase”1,2
 The post-discharge period is described as an “acquired, transient condition of generalized
risk” or “a period of vulnerability”. 1
 Comprehensive strategies should focus on factors during hospitalization and also during the
early recovery period soon after discharge to target stressors that probably contribute to
the vulnerability of patients. 1,2
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------1-Krumholz HM. Post-hospital syndrome – an acquired, transient condition of generalized risk. N Engl J Med. 2013;368;100-102.
2-Marti NC, Fonarow GC, Gheorghiade M, Butler J. Timing and duration of interventions in clinical trials for patients with hospitalized heart failure. Circ Heart Fail. 2013;6:1095-1101.
Initiating therapy during hospitalization is suggested to
reduce the risk of adverse outcomes1-2
 At discharge, patients can be considered to be in a stable chronic heart failure state at high
risk for adverse outcomes.1 -2
 “Initiating therapies in patients who are stabilized in the hospital and
continued long-term provides a potent option to improve long-term clinical
outcomes.”1
 “Delaying initiation of potentially effective therapies for weeks to months
post discharge risks unabated high risk for adverse events in the meantime.”1
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------1-Gheorghiade M, Shah AN, Vaduganathan M, et al. Recognizing hospitalized heart failure as an entity and developing new therapies to improve outcomes academics’, clinicians’, industry’s, regulators’, and payers’
perspectives. Heart Failure Clin. 2013;9:285-290.
2-Marti NC, Fonarow GC, Gheorghiade M, Butler J. Timing and duration of interventions in clinical trials for patients with hospitalized heart failure. Circ Heart Fail. 2013;6:1095-1101.