Collaborative partnership for optimizing heart failure outcomes in the long-term care environment: a clinical experience

RATIONALE

Heart failure (HF) is a devastating cardiovascular syndrome affecting more than 4.6 million Americans and resulting in a substantial economic burden. It is the number one cause of hospitalization in the older population. Because there is no cure for this costly disease, goals of therapy include; slowing progression, increasing patient survival, minimizing symptoms, improving patient functional capacity, and decreasing ER visits, hospital admissions, and readmissions. Studies have shown ACE inhibitors (ACEIs) to be extremely beneficial in reaching these goals. However, data nationwide indicate that less than half of HF patients are prescribed an ACEI. Therefore, a national long-term care pharmaceutical provider has committed to the development of a HF disease management program, which has been implemented through a collaborative partnership between medicine, nursing, and pharmacy. This report describes the experience and results of implementing this program in a large group of nursing homes.

METHODS

With help from an independent health outcomes consulting firm and an expert panel, a multifaceted program was developed. The AMDA heart failure guidelines were used as a foundation to design program interventions, which included educational programs for the long-term care facility staff, implementation of a HF treatment algorithm, and an outcomes measurement program. The primary goals of this program were to increase awareness of HF and treatment options available and to decrease morbidity and mortality associated with HF through the optimization of pharmacologic management in a long-term care setting.

OUTCOMES

A retrospective evaluation was conducted to assess changes in ACEI utilization, ACEI targeted dosing and HF-related hospitalizations 1 year after program implementation. A total of 510 patients followed by 23 consultants, representing 152 facilities met the inclusion criteria for the analysis. Data indicated an increase of 36% in newly enrolled HF patients utilizing ACEI after 1 year. A decreasing trend in HF hospitalizations was also noted from the first quarter, (2.2/100 patients) to the fourth (1.0/100 patients). The results of the Heart Failure-Health Outcomes Management Program (HF-HOMP) program demonstrate the opportunity existing for long-term care providers to improve patient health while minimizing expenditures. It also provides additional evidence that such programs should be implemented more broadly within this population.