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Strategies to Reduce Hospitalization in the Management of Heart Failure

Berkowitz, Robert MD, PhD, FACC; Blank, Lenore J. BSN, RN; Powell, Suzanne K. BSN, RN, MBA, CCM, CPHQ

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Progressive and debilitating heart failure (HF) affects almost 5 million, mostly elderly, individuals in the United Sates. As the elderly population grows in coming decades, the prevalence of HF is expected to increase substantially. In addition to its human toll, HF yields a substantial economic burden, with direct and indirect cost estimates ranging from $27 to $56 billion annually. It is associated with an unacceptably high rehospitalization rate—50% within 6 months—which not only drives burgeoning costs but also provides a signal that current management approaches to HF are less than optimal. Evidence-based treatment approaches, which include the use of β-blockers, angiotensin-converting enzyme inhibitors, spironolactone, and nesiritide, may offer opportunities for reducing mortality and rehospitalization rates in HF. Yet, because of inadequate discharge guidance and follow-up, many patients with HF are caught in a “revolving door” process that ultimately culminates in exacerbation and rehospitalization. Hospital-based disease management programs have consistently been shown to optimize care and reduce rehospitalization rates in patients with HF. The Hackensack University Medical Center HF program is discussed as an example of a successful HF program. This program represents a multidisciplinary, multifaceted approach to care that emphasizes case management. The core goal of this program is to provide a continuum of care that extends through hospitalization and into the patients' home environment.

Robert Berkowitz, MD, PhD, FACC, is founder and Medical Director of the Heart Failure Program at Hackensack University Medical Center in Hackensack, New Jersey. He has been involved in numerous clinical research trials such as COMPANION (A Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure) and FUSION (Follow-up Serial Infusions of Natrecor in Advanced Heart Failure patients) and is on the scientific advisory board of ADHERE (Acute Decompensated HF Registry). He has published multiple articles regarding both systolic and diastolic heart failure and the treatment of acute and chronic CHF. He is also involved in stem cell research as it relates to advanced heart failure, and acts as a consultant to many heart failure programs as well as pharmaceutical companies such as Scios and Biosite and has done research for the NIH and under the auspices of HUMC/UMDNJ.

Lenore J. Blank, BSN, RN, is the Administrative Manager of the Heart Failure Program at Hackensack University Medical Center, Hackensack, New Jersey. She has more than 20 years of experience in cardiac nursing, including critical care, home care, and the management of patients with congestive heart failure.

Suzanne K. Powell, BSN, RN, MBA, CCM, CPHQ, is currently the Director of Acute Care/Quality Improvement Program for Health Services Advisory Group (HSAG), Arizona's healthcare Quality Improvement Organization (QIO). Since 1995, she has worked with the HSAG in the capacity of Director of Case Management/CQI and managed various statewide healthcare projects. With 20 years of nursing, case management, and administrative experience, she has written four books on case management and is coeditor for CMSA's Core Curriculum for Case Management as well as Editor-in-Chief of Lippincott's Case Management Journal.

Address correspondence to Lenore J. Blank, BSN, RN, Hackensack University Medical Center, Hackensack, NJ 07601 (lblank@humed.com).

The authors have no conflict of interest.

© 2005 Lippincott Williams & Wilkins, Inc.