University HealthCare Alliance

February 22, 2020

Transitional Care Services Cost-Effective after Hospitalization for Heart Failure, Study Finds

A new study asserts that disease-management clinics, home visits by nurses and nurse case management should become the standard of care for elderly patients with heart failure after they are discharged from the hospital.

Elderly patients hospitalized with congestive heart failure have a poor prognosis and high risk of death and hospital readmission, so their post-discharge care can strongly influence their outcomes. 

Yet despite data showing that transitional care interventions, such as home visits by nurses, can reduce death rates and hospital re-admissions by more than 30%, many health systems have not implemented such programs. Health policy experts say this is due in part to cost concerns and doubts about the effectiveness of these delivery services.

Now, a team of Stanford Medicine and Veterans Affairs researchers has sought to assess whether transitional care interventions provide good value and better outcomes, as there are 5 million people living with congestive heart failure in the United States and 500,000 new cases diagnosed each year. Congestive heart failure is the stage of chronic heart disease in which fluids build up around the heart, causing it to pump inefficiently.

The researchers updated a 2017 study on the impact of transitional care intervention with four years of additional data. They then used it to compare standard post-discharge management regimes for patients 75 and older with three transitional post-discharge regimes for elderly patients that were determined to be most effective: disease management clinics, nurse home visits and nurse case management.

All three transitional care interventions delivered appreciable health benefits to the patient population, said Jeremy Goldhaber-Fiebert, PhD, associate professor of medicine at the Stanford School of Medicine and core faculty member of Stanford Health Policy.

The findings were published Jan. 28 in the Annals of International Medicine. Goldhaber-Fiebert is the senior author. The lead authors are Manuel Blum, MD, MS, a graduate student in epidemiology and clinical research at Stanford in 2019 and now on the faculty of the University Hospital of Bern in Switzerland; Henning Øien, PhD, a researcher at the Norwegian Institute of Public Health; and Harris Carmichael, MD, a Stanford/Intermountain fellow in population health, delivery science and primary care.

 “Transitional care interventions for older individuals with congestive heart failure — particularly nurse home visits — offer a high-value care alternative that could improve the health and longevity of millions of Americans,” he said.

The researchers said these transitional care services should become the standard of care for post-discharge management of patients who are 75 and older with heart failure.

Heart failure causes 1 in 8 deaths nationwide

The prevalence of heart failure is estimated to be 26 million people worldwide and growing. In the United States, 5.7 million adults have been diagnosed with heart failure, with an estimated annual medical cost of $39.2 billion to $60 billion. Total heart failure costs in the United States are expected to exceed $70 billion by 2030, the authors wrote. According to the Centers for Disease Control and Prevention, heart disease costs the United States about $219 billion each year as a result of health care services, medicines and lost productivity.

Of the 15 million Americans in their mid-70s and 80s today, about 1 million suffer heart failure.

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