Education, Early Intervention is Key to Improving OutcomesImproving healthcare outcomes for patients with heart failure is challenging. Research shows the opportunity for patient success is greater when the case management process begins in the hospital, where care managements can facilitate a successful transition to discharge and a strong cardiac rehabilitation plan.
In one study, researchers undertook a systematic review of 22 studies evaluating the impact of care management for patients with cardiovascular disease. Seventeen studies looked at patients for whom case management interventions were initiated in the hospital, and five studies looked at patients where interventions began after discharge.
The researchers found hospital-initiated case management had a greater impact on reducing unplanned readmissions and in reducing the length of stay. Although the evidence for case management initiated within the community was limited, there is strong evidence collaboration between community and hospital-based medical professionals builds a culture of health in the community and has a strong impact on patient care.
Cost of Cardiovascular Disease
Heart disease remains the leading cause of death in men and women, with nearly 25% of all deaths in the U.S. a result of cardiovascular disease. The Centers for Disease Control and Prevention (CDC) reports someone in the U.S. has a heart attack every 40 seconds, and every minute at least one person dies from a heart disease related event.
These numbers come at a high cost to the healthcare system, workforce, communities and families. The financial bill for this disease is nearly $555 billion each year in health care, medications and lost productivity.
In past years, having a heart attack or stroke often resulted in death. Recent advances have improved emergency response systems, treatment and preventive efforts, improving the odds of those who suffer from cardiovascular disease.
Still, the burden of heart disease continues to grow as the number of Americans suffering from obesity, poor diet, high blood pressure, and Type 2 diabetes continues to rise, according to the American Heart Association and American Stroke Association.
Coordinating Care and Education to Improve Outcomes
Multiple studies demonstrate higher levels of education and information reduces the risk of negative health conditions, including dementia, heart disease, and obesity. One study found that for every additional 3.6 years in education, there was a link to reduction in body weight, smoking and blood pressure, all of which are significant risk factors for cardiovascular disease.
Reductions in unplanned readmissions and mortality could be accomplished using a transitional program integrating hospital- and community-based case management to address disease management and home-based cardiac rehabilitation.
This becomes a service-based care management program creating partnerships across medical professions. This model has demonstrated a significant decrease in disease-related readmissions, and all-cause readmission. All without compromising patient satisfaction.
Developing a Care Management Framework
Guidelines for the care management of those suffering from cardiovascular disease should include the patient, family, workplace, and other professionals in the patient or client’s care. A collaborative and focused effort can have a significant impact on patient outcomes.
Most patients suffer from cardiovascular disease as a result of their life choices, which they may be unwilling to change. Using this four-pronged approach is powerful strategy to effect change:
- Education. The risk of cardiovascular disease rises dramatically when patients experience modifiable risk factors. This means although they may have these factors, their risk may be dramatically reduced by making different decisions. It’s important for care managers to share information and resources in areas such as weight management, smoking, exercise, poor nutrition, poor oral hygiene, alcohol use, etc.
- Collaboration. Case management is a collaborative process to meet the needs of an individual as they strive for greater overall health. Maintain relationships with those providing in-home care, cardiac rehabilitation in facilities and at home, primary care physicians, and insurance case managers.
- Communication. While communication skills are a learned art, it is never too late to start learning. Collaboration with professionals and with your patient requires structured and effective communication to form strong partnerships. While length of stay and cost of care are important considerations, preventing avoidable readmissions is also vital. Integral to reducing readmission is transition planning and collaboration, which requires strong communication.
- Satisfaction. Patients who are satisfied with their care are more likely to follow recommendations. Conversely, those who follow the recommendations have a lower risk of readmission.
In summary, by starting care management interventions before hospital discharge, and by utilizing strategies to engage patients in lifestyle changes that can improve health, case management teams can significantly reduce the potential risk of readmission in those suffering from cardiovascular disease.
Huntley, AL, Johnson, R, King, A (2016) Does Case Management for Patients With Heart Failure Based in the Community Reduce Unplanned Hospital Admissions? A Systematic Review and Meta-Analysis. BMJ Open. 6(5)
American Hospital Association (2016) Creating Effective Hospital Community Partnerships to Build a Culture of Health
Centers for Disease Control and Prevention (August 23, 2017) Heart Disease Fact Sheet
CDC Foundation (April 19, 2015) Heart Disease And Stroke Cost America Nearly $1 Billion A Day In Medical Costs, Lost Productivity
American Heart Association and American Stroke Association (2017) Cardiovascular
Maier, S. (June 25, 2019) More Years of Childhood Education May Reduce Adult Heart Disease Risk. University of California San Francisco
Heerema, E., Chaves, C. (August 7, 2017) How Higher Levels of Education May Reduce Dementia Risk. VeryWell Health
Science Daily. (May 22, 2019) More years spent in education associated with lower weight and blood pressure.
Carter, A., Gill, D., Davies, N. (May 22, 2019) Understanding The Consequences Of Education Inequality On Cardiovascular Disease: Mendelian Randomisation Study. The BMJ. 365:I1855
Amin, A., Hofmann, H., Owen, M. (2014) Reduce Readmission with Service-Based Case Management. Professional Case Management. 19(6):255