Heart Failure Hospital Readmission


  1. Summary of Heart Failure

Heart failure constitutes is one of the most significant and serious ailments to afflict human beings.  Heart failure, also known as called congestive heart failure, is the inability of the heart to perform its primary function of supplying blood to meet the body’s demand for nutrients and oxygen.  Symptoms of heart failure include, but are not limited to, shortness of breath, swelling in the extremities, and aerobic and anaerobic exercise intolerance. In most cases it is associated with the elderly and research shows that it is prevalent in the developed countries; it is, for example, the number one killer of men and women in the United States (NHLBI 2011).


This prevalence is attributed to the excess luxury that the citizens of such affluent countries enjoy. Treatment of the disease involves huge costs that are mainly encountered during the hospitalization (Lipsky 2008). A management pilot program to reduce hospital readmission for patients with heart failure is a worthy course.  The goal of the pilot is to show verifiable and representative data that a pilot program preempting the onslaught of heart disease by teaching and enforcing healthy living.  The key components of a program to avoid readmission for heart failure patients are education, sustainment, follow-up and individual accountability for healthy decisions.

  1. Comprehensive Exam Focus

Health Alliance of Detroit, MI has developed a program designed to help patients with heart failure avoid being readmitted to the hospital (HAP, 2011). The program involves extensive after-care that required the patient to actively participate in the program; it is believed that this involvement by the patient helps to assure better outcomes for those involved.

Patients in the program are assigned what the program calls “Nurse Health Coaches;” these coaches typically contact patients within 48 hours of their hospital discharge, and are involved in ongoing efforts to assist patients with the self-monitoring necessary to ensure the best possible outcomes. These coaches assess patients to determine eligibility for tele-monitoring devices, and provide other services, such as home-care educational materials and programs, all designed to spur the patients to the greatest levels of involvement in their own care.


Patients are instructed in methods of monitoring their own symptoms and test result, such as taking their own blood pressure and monitoring their pulse rate, breathing, and other health benchmarks. These home-assessed results are correlated with test and lab results provided ny the patient’s physicians; the combined results help to paint a comprehensive portrait of the patient’s overall health and the rate at which they are or are not responding to after-care treatment. In a short time, the HAP program showed a 14% decline in the rate o patients readmissions.


Capstone Scholarly Project

Heart disease affects more than six million citizens of the United States with more than 700,000 new cases being diagnosed every year. Health care facilities and hospitals have attempted to take measures to improve patient outcomes and performance in the provision of cardiovascular services. The effective management of heart disease can result in reduced cases of readmissions in particular cases. (Hines et al, 2010).

This disease is complicated and therefore requires modifications in lifestyle, including complex regimens of medication, exercise for physical fitness and checking one’s diet. (White et. al, 2010). In order to achieve the objectives of the project, it will be necessary for every heart disease patient to have a designated nurse caring for them. This will be more convenient if it is used to address both the outpatient and the inpatient cases. The discharging nurse will be responsible for completing the discharge time out (McAlister et al, 2001).

There exists a number of components which form a significant part of a management pilot program including educating patients and giving them support that facilitates the detection of de-compensation signs in addition to improving the adherence of the patients towards treatments. (McAlister et al, 2001). Nurses have to be exposed to extensive knowledge of the disease. The participation of nurses has been encouraged through the use of telephone follow-ups in the progress of the patients. It is therefore vital to teach the patients about the effectiveness of management pilot program concerning their hospitalization together with the possibility of death.






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