Heart Failure Bridge Clinic Addresses Symptoms Early
Date: October 30, 2012
When Vince Clews, a patient with congestive heart failure, suddenly gained 30 pounds due to a rapid increase in fluid buildup, he knew his diuretic medicine was no longer working. “My body had ballooned, my clothes didn’t fit and I felt terrible—physically, mentally and emotionally,” Clews says.
Instead of going to the emergency department or being admitted to the hospital, Clews was referred to the new Johns Hopkins Heart Failure Bridge Clinic, where he was treated with twice-weekly IV Lasix infusions for four weeks. “It turned my life around,” says the 68-year-old writer and video producer from Baltimore. “If that clinic had not been there, I’m certain I would have ended up in the ER or would have had to be hospitalized.”
Heart failure, a growing major health problem, is the number-one reason for hospital admissions for people age 65 and over. Nationally, about 25 percent of patients are readmitted within 30 days of their initial discharge. The goal of the Hopkins multidisciplinary heart failure clinic, which opened in January 2012, is to provide patients with greater quality of care by addressing symptoms early before they become more serious, thus preventing hospital admissions and readmissions.
Patients can come in when needed, Monday through Friday from 8 a.m. to 4 p.m. They or their doctor should call in advance. Patients typically can be seen within 24 hours of their call. The clinic is open to patients from throughout the Baltimore metro area, not just those cared for at Johns Hopkins.
When patients are discharged from The Johns Hopkins Hospital with a heart failure diagnosis, they are given an appointment to come to the Heart Failure Bridge Clinic within three to five days. The clinic is an example of an emerging new way of managing patients with chronic diseases, helping them transition from hospital care to home. The staff includes two nurse practitioners, one nurse and an exercise physiologist. Cardiologists are always available to consult or see patients at the clinic.
“The clinic provides a necessary support system for patients after their hospital discharge until their conditions have stabilized and they can see their doctor for regular visits,” says Stuart Russell, chief of heart failure and transplantation and medical director of the clinic. “Our early data from the first few months of the clinic’s operation show that our 30-day readmission rate dropped from 24 percent to 16 percent—a significant reduction that we think will continue with time.”
Russell says on average, patients are readmitted for worsening symptoms before their regular follow-up appointment with their doctor. Also, they may not have filled their prescriptions or they may be unsure of how to take them.
On patients’ first post-hospital visit to the heart failure clinic, the staff checks and reconciles their medications and fills medication boxes, as needed, to make it easier for them to adhere to their prescribed regimen. They also receive educational materials about their condition, counseling on limiting fluid intake and foods to avoid, and are made aware of the symptoms that should prompt them to call the clinic.
Clinic patients may also be given a six-minute walk test to measure their functional capacity to help assess their prognosis. “Results of the test may prompt us to change their care plan or refer them for evaluation for ventricular assist devices or a heart transplant,” says Russell.
For Vince Clews, the clinic was both a medical and emotional lifeline. “The staff provided me with a plan, and it’s clear what I’m supposed to do,” he says. “Without question, if that clinic were not there, I can’t imagine what would have happened.”