Background: Heart failure, particularly in patients with reduced ejection fraction (HFrEF), is a leading cause of hospitalization and readmission in the U.S., significantly impacting healthcare costs and quality of life. Improving compliance with guideline-directed medical therapy (GDMT) and early post-discharge follow-up is crucial to reducing readmissions. We describe a resident-driven quality improvement project aimed at increasing GDMT prescription at discharge and early follow-up through a comprehensive CHF action plan.
Purpose: This study, part of a multidisciplinary quality improvement project, involved 167 patients admitted for heart failure exacerbation at our hospital, which serves a population with low health literacy and high comorbidity burden. Using the PDSA framework over 8 months with monthly monitoring of process and outcome measures, we aimed to increase GDMT prescription at discharge and improve early follow-up through a comprehensive CHF Action Plan.
Description: Of the 167 patients, 57% were diagnosed with HFrEF. The median age was 65 years, with an average length of stay of 3 days. Compliance with GDMT prescription at discharge increased from 38% to 65% in patients with HFrEF. GDMT at discharge was strongly protective, with patients receiving it having significantly lower odds of readmission. Patients who missed their appointments were 48% more likely to be readmitted compared to those who attended.We collected baseline data on 30-day readmission rates, GDMT prescription, and follow-up completion. Interventions included GDMT initiation and optimization, extra diuretic prescriptions at discharge, a pharmacist-led medication reconciliation process, and ensuring outpatient follow-up completion at least within 30 days. Visual reminders via posters placed in the resident workstation outlined clearly defined tasks on the first three days of hospitalization. In addition, reminders were sent via EMR to providers to reinforce interventions. Process and outcome measures were monitored monthly. Baseline characteristics were summarized using descriptive statistics with categorical variables compared using chi-square or Fisher’s exact tests, and odds ratios calculated to assess associations. Of the 167 patients, 57% were diagnosed with HFrEF. The median age was 65 years, with an average length of stay of 3 days. Compliance with GDMT prescription at discharge increased from 38% to 65% in patients with HFrEF. GDMT at discharge was strongly protective, with patients receiving it having significantly lower odds of readmission. Patients who missed their appointments were 48% more likely to be readmitted compared to those who were adherent.
Conclusions: This quality improvement project successfully increased GDMT prescription at discharge and improved post-discharge follow-up, particularly for HFrEF patients. The results highlight the value of a multidisciplinary approach in optimizing heart failure care and reducing readmissions.