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Healthcare

As heart patients transition home from acute care settings, home care is critical to avoid readmission.

Compliance with discharge instructions is just the beginning of care for heart patients returning home. The ongoing use of diuretics to stabilize a patient’s dry weight is another example of in-home care that requires monitoring and understanding. 

Given the steady increase of heart patients age 65+ - and the pressure of the pandemic to keep patients home - it is becoming more clear that home care services can play a vital role for heart patients. 

Making the case for home care: Preventing noncompliance in discharge instructions

Nearly 20 years ago, an American Family Physician report said that as many as 50% of patients discharged from the hospital following heart failure do not adhere to discharge instructions. “A single home health visit may decrease hospital readmission for treatment of heart failure,” the study said presciently. “Many excellent heart failure protocols and critical pathways are available for use by home health nurses.”

More recent study has reached similar conclusions:

  • “Patients with [heart failure] who received a combination of early and intensive [home care] combined with an outpatient clinician visit within the first 7 days after hospital discharge were significantly less likely to be readmitted to the hospital within 30 days.” [2017]
  • The American Heart Association (AHA) concurred: “Patients who receive home health care after a heart attack are less likely to be admitted to the hospital within 30 days after discharge.” [2020]

U.S. Heart Attack Patients

Only 10% Receive home care after discharge

Despite the known effectiveness of home care in reducing readmission for heart patients, change is happening very slowly. This data point from the American Heart Association (2020) clearly identifies an opportunity for qualified home care organizations to play a more significant role in caring for heart patients at home – and reducing readmission following discharge.

Home Care & Home Diuretic Protocol: Keeping patients dry

Patients who receive diuretics in acute care are sometimes sent home before sufficient body fluids are removed. “That is the wrong approach,” according to Ryan J. Tedford, MD, heart failure specialist at Johns Hopkins School of Medicine in Baltimore. “We want to get rid of all of the fluid.” 

However, there’s evidence to suggest that “wet” patients who return home can do so with reduced risk – when home care is involved.

A MaineHealth study reported in 2014 that a Home Diuretic Protocol (HDP), managed and reported by home health nurses, “can be delivered effectively and safely to improve outcomes, reducing readmissions and allowing patients to remain at home.” 

In regard to maintaining dry weight specifically, the study claimed, “overall, a return to baseline weight was achieved in 64 of the 84 HDP activations. Of the 68 activations for which the HDP was followed without deviation, a return to baseline weight occurred in 64 (94%), with only 6 hospitalizations.”

SeniorBridge Clinical Manager Nira Monero, added that administering diuretics is not always a clear-cut decision. “Our home care patients have orders in place from their doctor,” she said, “and most are on Lasix or another diuretic. An RN will sometimes initiate diuretics because of edema or swelling, but the symptoms aren’t always clear-cut, so we need to monitor very carefully.”

Use of Home Diuretic Protocol

0
Adverse outcomes observed

10%
Readmission rate

97%
Clinician and patient satisfaction

A MaineHealth Study found that Home Diuretic Protocol could be effective when used in a home health delivery system that also included telemonitoring. Nurses managed the protocol and reported data.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide. 

SeniorBridge offers an integrated care management practice model that involves two components:
1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on home care support services for heart disease, contact SeniorBridge.

Sources consulted:
Oxford Academic/European Heart Journal (2005)
American Family Physician (2001)
Today’s Hospitalist (2014)
US National Library of Medicine (2017)
American Heart Association (2020)
US National Library of Medicine/NIH (2014)

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