Nearly five million Americans currently live with congestive heart failure (CHF) and approximately 550,000 new cases are diagnosed in the U.S. each year according to statistical data from the Centers for Disease Control and Prevention (CDC).
It is responsible for 11 million physician visits annually, and more hospitalizations than all forms of cancer combined. CHF is the primary diagnosis in 875,000 hospitalizations per year, and the most common diagnosis in hospital patients age 65 years and older. In that over-65 age group, one-fifth of all hospitalizations have a primary or secondary diagnosis of heart failure (HF).
The incidence of CHF is equally frequent in men and women, however, African-Americans are 1.5 times more likely to develop heart failure than Caucasians. More than half of those who develop CHF die within five years of diagnosis, and the diagnosis contributes to approximately 287,000 deaths a year in the U.S. It is also important for healthcare teams to understand that sudden death is common in patients with CHF, occurring at a rate of six to nine times that of the general population. It is estimated that beyond costs in length of life and disability, the total monetary costs, including indirect costs for HF, will increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be three-fold higher ($160 billion in direct costs).1
Heart failure tends to have several antecedent risk factors. The American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) Heart Failure Guidelines now classify people possessing many of these risk factors as having “Stage A” heart failure. The most common risk factors that are implicated are hypertension (HTN), coronary artery disease (CAD), myocardial infarction (MI), diabetes mellitus (DM), some diabetes medications such as rosiglitazone and pioglitazone, sleep apnea, congenital heart disease (CHD), valvular heart disease (VHD), certain viral infections such as human immunodeficiency virus (HIV), alcohol use, tobacco use, obesity and tachyarrhythmias such as atrial fibrillation (AF).
With improving therapies and risk factor interventions, deaths from heart failure have decreased on average by 12 percent per decade for women and men over the past 50 years. Unfortunately, despite evidence-based guideline utilization, the likelihood of morbidity and re-hospitalization remain high. Re-hospitalization rates in the U.S., on average, approach 25 percent of patients within 30 days of discharge and by six months, this proportion reaches nearly 50 percent.2,3 Some of these are related to the primary disease process, but nearly one-half to two-thirds of these readmissions appear to be triggered by potentially remediable factors, including poor discharge planning, nonadherence to recommendations regarding diet and medical treatment, inadequate follow-up, poor social supports and delays in seeking medical attention.4,5,6
Since 2012, the Centers for Medicare & Medicaid Services (CMS) has begun penalizing hospitals for what it has defined as an “excess readmission ratio.” This has placed further burdens on hospital systems as the rate at which hospitals are penalized will be an increasing incremental total rate over a period of time if they fail to achieve certain readmission metrics over the years. Learn more
Given the confluence of epidemiology, cost implications, availability of established guidelines and effective treatments, as well as observed variability in hospital clinical practice and transitional care practices, CHF represents a high-impact target for inpatient quality improvement (QI) initiatives. There are multiple factors that must be considered in inpatient care as well as the “hospital to home” transition to effectively improve the outcomes and readmission rates in this patient population.7 It has generally been noted that a single process intervention is not likely to be effective, and a more comprehensive approach is necessary to affect outcomes.8
Optimizing HF care during and after hospital admission episodes will benefit both patients and healthcare delivery systems.
This Implementation Guide is supported in part by an unrestricted grant from AMGEN.
The Congestive Heart Failure Toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by CHF Toolkit Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.