Nancy Rizzuto is an adult nurse practitioner and the Director of Nursing, Critical Care, and Cardiology Services, Brookdale University Hospital, Brooklyn, New York.
Greg Charles is a program director for Cardiology Services and an angioplasty specialist, Brookdale University Hospital.
Crit Care Nurse. 2022 Aug 1;42(4):13-19. doi: 10.4037/ccn2022417.
Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes.
For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%.
A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge.
The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions.
Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes.
The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.
心力衰竭影响了大约 620 万美国成年人，其年估计全国成本为 307 亿美元。尽管在治疗方面取得了进展，但心力衰竭仍是导致住院再入院的主要原因。不遵守治疗计划、缺乏教育以及无法获得医疗保健是导致预后较差的原因。
对于心力衰竭患者，全国范围内的平均再入院率为 21%，纽约州为 23%。在试点心力衰竭计划开始之前，研究机构的 30 天再入院率为 28.6%。
一个多学科团队创建了一个心力衰竭自我护理试点计划，该计划在一家医院的遥测病房中实施，涉及 47 名患者。患者接受了有关疾病进程、药物、饮食、运动和早期症状识别的教育。患者在出院后 48 至 72 小时内会接到随访电话，并在出院后一周内由心脏病专家进行检查。
实施试点计划后，心力衰竭的 30 天再入院率下降了 16.6%，这提高了患者对药物和治疗计划的依从性，并减少了再入院。
试点计划中的患者代表了不同的背景。社会经济因素，如负担得起的健康食品选择和资源获取的便利性不足，与较差的预后相关。
基于证据的心力衰竭计划提高了知识水平，早期症状识别，生活方式的改变，以及对药物、治疗计划和随访预约的遵守。多学科团队方法用于心力衰竭计划减少了护理差距，并改善了护理的协调和过渡。
