Impact Of Aggressive Transitional Care Strategies On Reducing Adverse Outcomes In Veterans Hospitalized For Acute Decompensated Heart Failure

Introduction Patients hospitalized with acute decompensated heart failure (ADHF) have high readmission rates and mortality. The aim of this study was to evaluate the impact of a post-discharge Heart Failure Access Clinic (HFAC) visit on 30-day ADHF readmission and mortality rates. METHODS Admissions to the Madison VA for ADHF between April 2018 and May 2019 were assessed retrospectively. Exclusions were as follows: death during index admission, referral to hospice, post-discharge care at an outside VA, LVAD/transplant, and ineligibility for HFAC. For veterans with multiple admissions during this time period, only the first hospitalization was analyzed. Demographic, laboratory, and clinical data were collected. Readmissions for ADHF at 30 days and all-cause mortality at 15 months were analyzed. Categorical outcomes were compared using chi squared test/Fisher\u0027s test, continuous variables via one-way ANOVA and Kruskal Wallis tests for non-normal data. RESULTS Of the 142 patients offered HFAC, 119 patients were seen (84%). Demographics are shown in Table 1. Patients who were offered HFAC and not seen were more likely to be active smokers, have higher systolic BP, and have shorter hospital stays. On average, patients were seen in HFAC 8.7+/-5.1 days after discharge. Reasons for not being seen in HFAC: readmission (n=7), patient preference (no show =5, cancel =5, decline =3), and scheduling error (n=3). No patients died prior to the scheduled HFAC appointment. Patients seen in HFAC had lower 30-day readmission rates (15.8% vs 39.1%; p=0.01). Despite comparable predicted death rates (MAGGIC risk calculator), all-cause mortality was substantially lower in patients seen in HFAC versus those who were not seen (Figure 1). CONCLUSIONS Veterans who were offered HFAC but not seen had a significant increase in 30-day readmission rate and all-cause mortality. The difference in readmission rate was attributable to pre-HFAC hospitalizations within 1 week of discharge, suggesting the need for earlier HFAC appointments. Further study needs to be undertaken to determine whether the HFAC visit is responsible for the reduction in all-cause mortality.