January 1, 2018Open Access
Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age
Key Result
Current heart failure guidelines exhibit significant gaps in addressing the complex needs of elderly patients and those with multiple comorbidities, contributing to ongoing hospital readmissions.
Structured PICO
What are the gaps in guidelines and clinical practice contributing to readmissions in older patients with congestive heart failure and multiple comorbidities?
P
Population
Patients with congestive heart failure, multiple comorbidities (diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea), and older age/frailty.
I
Intervention
Multidisciplinary care within a CHF program delivering gold standard therapies.
O
Outcome
Hospital readmissions
This review highlights critical gaps in translating heart failure guidelines into clinical practice for complex, elderly patients with multiple comorbidities, which drives preventable hospital readmissions.
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.