J-LSMS | Abstracts | 2020 Annual LaACP Meeting

Title : A multidisciplinary quality improvement plan to reduce 30 day heart failure readmissions

Manith Bondugula MD, Renni Panicker MD, Rebecca Lee DO, Karim Habbal MD, Tristan Dao, MD, Nethuja Salagundla MD. University Hospital and Clinics Lafayette Louisiana.

Background: Congestive heart failure (CHF) affects 5.7 million adults in the United States. Approximately 50% of patients will die within 5 years of diagnosis 1 . New federal guidelines regarding readmissions have also posed a challenge in this patient population. CHF readmission varies from 17.0% to 28.2% 1 . With the current financial burden of CHF and the incidence of CHF projected to increase by 46% by 2030 2 , the readmission rates will likely see a dramatic rise as will the national healthcare financial burden. Objectives: The project aim was to reduce the 30-day CHF readmissions. Measurement of CHF readmissions for a 8 month period was retrospectively evaluated for comparison to our 8 month period in which quality measures were instituted. Methods: A multidisciplinary approach was utilized to reduce CHF readmissions. A standardized education system was utilized by physicians and nurses prior to discharge. Specialized nurses assessed barriers to patient care. Nutrition experts were consulted to educate the patients on diet. Each patient was given a scale, a blood pressure cuff, a water bottle for accurate intake measurement, and instructions for a Lasix sliding scale. Patients were scheduled for clinic follow-up with the resident clinic within 10 days of discharge. Results: From October 2018 to May 2019, the cumulative CHF readmission was 15.38%. The quality measures were then applied, as outlined above. The subsequent CHF readmission over the following 8 months was 8.75%. To compare the overall case numbers, in the months prior to the intervention there were a total of 91 outcome cases with 14 readmissions from October 2018 to May 2019. After the intervention, there were 80 outcome cases with 7 readmissions. Prior to the intervention the average readmissions per month was 2. After the intervention, the average readmission per month was 1. Conclusion: The overall goal of the project was to reduce CHF readmissions, and our multi-disciplinary approach achieved this goal. This project brings light CHF readmissions on a national level and challenges other hospitals to seek out ways to improve their approach to CHF admissions. We must accept that the overall disease burden will continue to increase with time and it is our responsibility as healthcare professionals to be more vigilant and do our part in finding both innovative and effective solutions. References 1. Boback Ziaeian a,b and Gregg C. Fonarow c, “Prevention of Hospital Readmissions in Heart Failure” Prog Cardiovasc Dis. 2016 Jan-Feb; 58(4): 379 – 385. 2 .American Heart Association News “Heart Failure Projected to Increase Dramatically according to new statistics” American Heart Association January 25 th 2017 3.Jerome L. Fleg, MD “Preventing Readmission After Hospitalization for Acute Heart Failure: A quest Incompletely Fulfilled” JACC: Heart Failure Volume 6, Issue 2, February 2018

Cardiac Pauses in Critically Ill Coronavirus Disease-2019 Patients

Juan I. Solorzano 1 , MD; Keerthish C. Jaisingh 2 , MD Hajra Awwab 3 , MD; Sampath

Singireddy MD 4 ; Steven Bailey, MD 5 ; Paari Dominic, MD 6

1, 4, 5, 6 Department of Medicine and Center for Cardiovascular Diseases & Sciences,

Louisiana State University Health Sciences Center - Shreveport

2, 3 Department of Internal Medicine, Louisiana State University Health Sciences Center -

Shreveport

Correspondence:

Paari Dominic, MD

Assistant Professor of Medicine

Div. of Cardiology, Dept of Medicine

Louisiana State University Health Sciences Center

1501 Kings Hwy, Shreveport, LA 71103, USA

Phone: (318) 675-5941, Fax: (318) 675-5686

E-mail: [email protected]

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus

known to cause coronavirus disease 2019 (COVID-19), has affected more than 38 million

globally. Studies from around the world have reported cardiac dysrhythmias in patients

infected with COVID-19. A case-series from New York with 393 patients showed that

7.4% of patients had arrhythmias during their hospital stay. Specifically, patients who

received invasive mechanical ventilation were more likely to have atrial tachy-arrhythmias

(17.7%). A study from Italy found a statistically significant rise in out-of-hospital cardiac

arrests in 2020 when compared to the same period in 2019. Another case series with 187

COVID-19 patients from China, found that 27.8% of patients had myocardial injury, which

resulted in cardiac dysfunction and arrhythmias. Elevated troponin levels were associated

with more frequent ventricular tachycardia and ventricular fibrillation. However, >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6-7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34-35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57

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