HOSPITAL READMISSION AFTER HEART DISEASE
Introduction
Cardiovascular diseases represent a group of conditions that affect the heart. The diseases are known to cause massive deaths in the world thus raising concern in the health sector. Diseases under the bracket include blood vessel conditions like coronary heart disease and heart defects that are congenital. Cardiovascular conditions represent diseases that involve the narrowing or blockage of the blood vessels resulting to heart attacks, strokes and chest pain (Frishman and Alpert, 2013). Many people in the world suffer from cardiovascular diseases, and hospitalization and treatment form the common measures used in managing the conditions. In the recent past, re-admission after the management of cardiac conditions has become a common occurrence in the United States and the outside world. This article addresses the issue of readmission following treatment of cardiac conditions to determine the causes and the possible management of the problem.
Background Information and interventions
Most of the cardiovascular diseases are caused by modifiable lifestyle factors, and the diseases can be managed if the risk factors are controlled. According to the world health organization, cardiovascular diseases are the leading cause of death in the world. Statistics in 2015 revealed that a total of 17.7 million people died from heart diseases in the world (Benjamin et al., 2017). The population represents 31% of global deaths leaving a question of what should be done to control the death rates. Coronary heart diseases lead to the number of deaths followed by stroke, and the deaths are prominent in low-income countries. The problem under is readmission after treatment of individuals. According to the HFSA annual meeting Dallas, the number of patients readmitted due to heart failure is low, but the total number of deaths from the conditions is still high (Frishman and Alpert, 2013). The report indicates that the readmission rate from 2009-2016 decreased by 89%, but the number of deaths increased at a rate of 73%. Reports from the CDC indicate that about 610,000 people die every year due to heart diseases in the United States (Benjamin et al., 2017). More than half of the yearly deaths occur in men. Other current statistics indicate that Coronary heart disease (CHD) is the leading cause of death in the United States killing over 370,000 people annually. Heart disease has increased to be a life-threatening condition in the US with approximately 735,000 people experiencing heart attacks yearly
The federal government of the United States launched a readmission programme in 2012 designed to impose penalties on hospitals that would receive the highest number of readmissions. The patient protection and affordable care act (PPACA) mandated the program with the aim of improving the quality of life and the continuity of care. Recent research indicates that approximately 20% of medical care recipients experience readmission within 30 days of discharge from healthcare facilities (Frishman and Alpert, 2013). The common reasons that have been identified to cause readmissions in patients with heart conditions include increased age, advanced stages of the conditions, acuity of the illness and the socioeconomic factors.
Nursing interventions can be used to minimize the number of readmissions of heart conditions. A complete health assessment before discharge is necessary for the prevention of readmissions. Patients are likely to come back for treatment if they were prematurely discharged. The second nursing intervention under scrutiny is health education during discharge. In most cases, patients are given health education by nurses and nutritionists during discharge. If the message was not passed correctly during the discharge, it might lead to readmissions. As indicated earlier, cardiovascular diseases are caused by modifiable risk factors which can be controlled with relevant health education and lifestyle choices. If the nurses fail to give relevant health education, the progression of the diseases is faster causing readmission. The topic of readmission is important to nurses because it identifies the risks causing readmission and the possible ways of preventing the problem. Patients are likely to benefit from the research because they can avoid the factors leading to readmission while at home.
Analysis of Research
Readmission following hospitalization with cardiovascular conditions is a common occurrence globally. Research has been conducted to address the issue to reveal the causes and the prevention of readmissions after discharge. Dulay et al., (2016) conducted community research to examine readmission thirty days after discharge in patients with myocardial infarction. The study acknowledged that readmission after discharge is a common problem. A retrospective cohort study was conducted in a population of 3010 patients diagnosed with myocardial infarction in Olmsted County. The data collected from the database included patients admitted from the year 1987 to 2010 and survived hospital discharge. Subsequent readmissions from the selected population were identified, and a manual charting was done to detect the reason for readmission. The results from the study indicated that 18.6% of the patients selected were readmitted and 42.6% of the readmissions were due to myocardial infarction. The reasons found to lead to the readmission include complications of treatment and surgery, longer stay before discharge and a higher Killip class.
Congenital heart disease (CHD) represents one of the heart conditions that affect people in Canada especially children. A research was conducted to determine the readmission rates among people in Canada affected by CHD and to examine risk factors associated with the readmission (Islam et al., 2015). A retrospective study was used to identify patients from the Canadian hospital database admitted and discharged with CHD. The study analyzed discharges from the year 2003 to 2012, and an index follow-up of up to 12months post discharge was done. The results of the study indicated that the readmissions per 1000 CHD patients were 48 within two weeks, 83 within one month and 353 within one year. The reasons for readmission included longer hospitalization stay, male sex predisposition and complex CHD in patients.
Heart failure is a condition that is difficult to manage, and the discharged patients have shown a pattern of readmission in various hospitals. A literature review was done to determine the characteristics measured during discharge that predisposes individuals to readmission in the United States (O’Connor et al., 2016). The information was gathered from the internet, and a total of 34 studies were selected and analyzed. Results from the research indicate that patient characteristics have a modest effect on readmission after discharge. Sociodemographic, financial constraints, comorbidities, and individual heart behavior are some of the factors found to cause readmissions.
Significance to Nursing Practice
The nursing practice adopts the QSEN competencies to improve the quality of care and safety of patients through diverse ways. The research on readmissions following cardiac disease indicates that there is information that can be used to avoid future mistakes during discharge as a measure of minimizing the cases. From the research, the nurse can use evidence-based practice to manage heart conditions effectively thus avoiding unnecessary readmissions. The studies also indicate that the nurses should stick to the standards of practice by offering quality services to the patients. Nurses can prevent readmissions through proper history taking and provision of health education during discharge. Through the interventions, the national and global rates of readmission could be reduced.
Conclusion
Evidence from the research conducted indicates that the major cause of readmission in heart conditions is a long period of hospitalization. Cardiac conditions are the leading cause of global death and research should be conducted to determine the reasons behind the long stay of patients in the hospital. Perhaps if patients suffering from cardiac conditions could be treated and discharged home earlier, the global pattern could be reduced. Further research should be conducted to determine the effectiveness of health education given by nurses during discharge as a measure of controlling cardiovascular conditions.
References
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … & Jiménez, M. C. (2017). Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation, 135(10), e146-e603.
Dulay, S. M., Weston, S. A., Illian, J. M., Bell, M., Jaffe, A. S., & Roger, V. L. (2012). Thirty day hospital readmissions following acute myocardial infarction: a community study. Ann Intern Med, 157, 11-18.
Frishman, W. H., & Alpert, J. S. (2013). Reducing hospital readmissions for cardiovascular disease: is it feasible?. The American journal of medicine, 126(9), 753-754.
Islam, S., Yasui, Y., Kaul, P., & Mackie, A. S. (2015). HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA. Canadian Journal of Cardiology, 31(10), S124-S125.
O’Connor, M., Murtaugh, C. M., Shah, S., Barrón-Vaya, Y., Bowles, K. H., Peng, T. R., … & Feldman, P. H. (2016). Patient characteristics predicting readmission among individuals hospitalized for heart failure. Medical Care Research and Review, 73(1), 3-40.
