Evaluating the Effects of Heart Failure Clinic Enrollment on Hospital Admission and Readmission Rates: A Retrospective Data Analysis

Abstract

Heart failure (HF) is a clinical syndrome associated with high morbidity and mortality with a large economic burden, and is the leading cause of hospitalizations among Medicare beneficiaries in the United States. Healthcare reform has focused on strategies to reduce HF readmissions, including outpatient HF clinics. Purpose: The purpose of this DNP Project was to answer the following question: In adult patients diagnosed with HF, how does enrollment in the HF clinic, compared to non-enrollment affect hospital admission and readmission rates? Methods: A retrospective analysis of 767 unique patients and their 1,014 respective admissions and readmissions was conducted. Continuous and categorical data was analyzed and presented as a mean (M), standard deviation (SD), absolute number (N) and percentage (%). A Pearson Chi Square test was used for categorical variables and Analysis of Variance was used for age and ejection fraction (EF). Results: Study sample demographics (N=767); age (M=79.72, SD=7.48); gender (57.6 % male) and EF (M=0.43, SD=0.16) were evaluated. The No HF clinic (No HFC) and HF clinic (HFC) enrollment groups (N=573) were compared for age (M=79.49, SD=7.65) (M=80.39, SD=6.94), male gender (54.6%, 66.5%) and EF (M= 0.44, SD=0.17) (M=0.42, SD=0.15), respectively. Each sample patient had at least one admission for HF during 2015; of which 573 (46.2%) were in the No HFC group and 194 (8.4%) were in the HFC group (p<0.001). There was no difference in all-cause readmissions between the No HFC group [n=95(14.5%)] and the HFC group [n=37(16.2%)] (p=0.534) and no difference in HF-related readmissions between the No HFC group [n=72(11.0%)] and the HFC group [n=23(10.0%)] (p=0.700). Conclusions: This DNP project demonstrated a significant difference in HF admission rates in favor of the HFC group. While no differences were found in all-cause or HF-related readmission rates in No HFC and HFC groups, the rates are less than the national average. Unintended findings were that datasets can be very poorly constructed and populated, resulting in large amounts of unusable data. Recommendations are for more rigor in the organization of datasets to assure accurate comparisons between admission and readmission rates based on enrollment in HF clinics.