Tech & Touch: Keys to Successful Heart Failure Management

Heart Success has single-digit 30-day readmission rates for heart failure. Here is how it meets that challenge.

The burden of disease as measured by either the number of affected individuals (5.7 million Americans), healthcare utilization (1.1 million hospital discharges, 3.4 million physician office visits, 668,000 emergency room visits) or economic burden (estimated at $40 billion annually in the U.S.) is staggering. Heart failure is the only major cardiovascular disorder whose prevalence is growing. Understandably, there is increasing emphasis on methods for improved disease management. 

Metrics including 30-day readmissions have emerged as yardsticks for assessing interventions and as key elements of pay-for-performance programs. With its heart failure program, “Heart Success,” Atlantic Health System, a five-hospital tertiary care system serving northern New Jersey and Eastern Pennsylvania, has achieved 30-day heart failure readmission rates of 5 to 7 percent vs. national averages in the 20 to 25 percent range. What have been its keys to success? A combination of patient-centered “high touch” with “high tech.”

Based at Morristown Medical Center’s Gagnon Cardiovascular Institute, the program incorporates team-based care with physicians, nurse practitioners, nurses, social workers, educators and dietitians who provide coordinated inpatient and outpatient care. Access to established and emerging treatments including medications, optimized cardiac contraction with pacemakers capable of cardiac resynchronization and implantable defibrillators for the prevention of sudden cardiac death is essential, with temporary and permanent assist devices available to those with advanced disease.

However, equally important is the personal connection, without which medication and dietary noncompliance will go undetected, follow-up visits will be missed and warning signs of decompensation will be ignored. While provider-patient communication certainly employs the basics, technology plays an increasingly important role in allowing healthcare providers to detect early decompensation and intervene. 

The Heart Success program increasingly uses mobile health tools to communicate between patients and providers. Patients use tablets to routinely answer a set of heart failure-specific questions and to transmit this behavioral and symptomatic information to the Heart Success team. The process takes less than a minute and the information allows risk stratification that can prompt, for example, contacting patients for additional evaluation and management changes.

Technologies that help monitor and manage patients collect and transmit vital signs and data on symptoms and behaviors. Other devices can capture physiologic information and transmit it wirelessly in real time. With published preliminary data on 30-day readmission rates, the Heart Success program has been awarded a Verizon Corporate Citizenship – Healthcare Grant to evaluate the impact of these remote technologies on outcomes in patients with advanced heart failure.

With this strategy, dramatically improved outcomes  are achievable. This is good news for our patients and the healthcare system.

Linda D. Gillam, MD, MPH, is chair of the Department of Cardiovascular Medicine at Morristown Medical Center/Atlantic Health System in Morristown, N.J.