Lower acute MI patient readmission rates tied to heart care navigation teams

Utilizing heart care navigation teams may reduce 30-day readmission rates in patients with acute MI, according to data presented at the ACC Cardiovascular Summit.

William E. Downey, MD, FACC, medical director of interventional cardiology at the Sanger Heart & Vascular Institute, Atrium Health, in Charlotte, North Carolina, and colleagues compared data of patients treated for acute MI between July 2016 and June 2017, before the start of the program, and between July 2017 and June 2018, after the start of the program.

“After a heart attack, the time between a patient’s discharge and their first follow-up appointment can be a scary time for patients,” Downey said in a press release. “In the past, if something happened that caused concern to the patient, we’d tell them to call the office, where they often didn’t know anyone. Now, patients have a nurse navigator they know who gives them their cell number and can provide reassurance or a sound plan for taking action if needed. It’s an important bridge until the patient develops a firm relationship with their new cardiologist’s office.”

Sanger’s heart care navigation team began in 2017 with patients assigned a health advocate and a full-time acute MI nurse navigator to provide in-hospital education, care coordination and quality improvement as well as addressing patient concerns up to 90 days after discharge, the researchers wrote.

Downey and colleagues found 30-day acute MI same-facility observed/expected readmission ratios were higher in the group of patients analyzed before the start of the program compared with the group of patients who had the program (0.58 vs. 0.42; premier top decile = 0.69). In the year before the program was implemented, the 30-day readmission rate was 6.3%; in the year after, it was 3.7%.

The 30-day acute MI mortality rate was lower among patients who had the program (4.57% vs. 5.75%).

Follow-up appointments made before discharge were higher among patients who had the program compared with those who did not (96% vs. 78%), according to the researchers.

Cardiac rehab referrals were higher in the heart care navigation group (88.6% vs. 85.7%), as was defect-free care (85.1% vs. 83.3%), according to the researchers.

“This study shows that nurse navigators are an integral part of reducing heart attack readmission and mortality,” Amber Furr, BSN, RN, CPHQ, performance improvement coordinator at the Sanger Heart & Vascular Institute, said in the release. “We’re not where we want to be yet with cardiac rehab referrals or guideline-driven care, but we have seen an improvement.” – by Earl Holland Jr.

Reference:

Furr A, et al. Poster Presentations. Presented at: American College of Cardiology Cardiovascular Summit; Feb. 14-16, 2019; Orlando.

Disclosures: Downey reports he received personal fees from Medtronic. Cardiology Today could not confirm relevant financial disclosures for Furr at the time of publication.