Improving Care for Patients with CHF

Heart failure is a common clinical syndrome associated with high morbidity and mortality.  It is a significant public health problem, with a prevalence of over 5.8 million people affected in the US according to the CDC.    The prevalence is high and increasing; the number of patients is expected to rise to 8.5 million by 2030.   Patient care costs the nation an estimated $30.7 billion each year, including the cost of health care services, medications to treat heart failure, and missed days of work.

Outpatient disease management is necessary for patients with heart disease as 83% of patients hospitalized at least once and 43% are hospitalized at least four times.  One of the most critical and challenging issues for the healthcare ecosystem is to find innovative approaches to reduce the high hospital admission and readmission rates of these patients – especially those affected by congestive heart failure (CHF).  Controlling the frequency and/or severity of rehospitalizations is critical to maximizing the quality of life for the patient while managing the costs of care.  

Following discharge, home health agencies can use a virtual care communication platform to address and engage CHF patients.   Video-based virtual visits allow agency clinicians to review the patient’s condition, address patient’s barriers and issues to lifestyle changes, and also reconcile medications with prescribers and pharmacists in real-time.  Emails, secure messages, and texts can also be used in between virtual visits to:

  • Teach patients behavioral modifications
  • Encourage exercise and physical rehabilitation
  • Reinforce dietary adjustments and nutritional needs
  • Educate patients about their medications and improve compliance

Patients value the ongoing support provided in the cadence of touchpoints.  Family caregivers value the ability to receive real-time guidance and support from home health staff which deepens their confidence in being able to provide their loved one with optimal care.  And, both patients and caregivers appreciate the convenience of being able to immediately access their home health clinicians for critical health-related needs and/or quick questions regarding more routine health care matters.   

By maintaining frequent contact with these patients, home health clinicians can adjust patient care as needed and quickly intervene if the patient’s situation needs immediate intervention.  Better management and engagement of these patients will help agencies minimize the number and length of hospital stays, leading to improvements in quality of life and cost of care.

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