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Reducing Rates of Readmission and Development of an Outpatient Management Plan in Pulmonary Hypertension: Lessons from Congestive Heart Failure Management

Justin Dolan

Starlet Harrimon

Jinesh Mehta

V. Navas

James Tarver


Murali Chakinala


Franck Rahaghi

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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1023

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7, 2017

Purpose

The aim of the abstract to review individual studies and comprehensive meta-analyses to identify effective interventions with Congestive Heart Failure that can be used to develop similar disease management programs in Pulmonary Hypertension and ultimately reduce hospital re-admissions.

Background

Pulmonary Hypertension currently has minimal guidelines for outpatient disease management. Heart failure is the most common cause for readmission for patients with both Pulmonary Hypertension and Congestive Heart Failure. CHF studies have shown that disease management plans are effective in reducing CHF readmissions.

Methods

A comprehensive review of literature performed from 1993 to 2009, including original trials and meta-analysis and reviews. We reviewed the topics of outpatient CHF interventions to decrease CHF mortality and readmission and patient management strategies in CHF.

Results 

The most studied interventions included case management (CM-specialist nurse driven, education pre/post discharge, specialist nurse home visits, scheduled telephone calls for symptom management, when to seek help), multidisciplinary Intervention ( MI-coordinated interventions and communications; specialist nurse driven, patient-caregiver education regarding disease, medication and diet, nurse clinic visits, regular telephone calls, individualized follow-up plan, access to physician, nurse, dietician, pharmacist, social worker), remote monitoring programs consisting of structured telephone strategy (STS-monitoring collected data via human-human or human-machine interactive response system) or tele-monitoring (TM-physiologic data transmission of EKG, blood pressure, weight, respiratory rate digitally). Clinic visits did not have a significant effect on CHF readmission or mortality. CM showed decreased all-cause mortality (ACM) at 12 months, all-cause re admission (ACR) at 12 months and CHF readmission at 6 and 12 months. MI resulted in decreased ACR and CHF readmission. There was some discrepancy on effectiveness of TM programs alone in individual studies, however large meta-analysis suggests TM provided a reduction in ACM and risk of CHF hospitalization. STS had similar results to TM including decreased risk of CHF hospitalization, without an effect on mortality.

Conclusion

Extrapolating from CHF data, it seems that strategies to improve the health of PH patients and the development of comprehensive care programs should include structured telephone strategy and/ or tele-monitoring, case management strategies and multi-disciplinary interventions