For patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is an important goal.
Learn how UVA works to keep heart failure patients living safely at home from a heart failure specialist who works in UVA’s Heart Health at Home program.
Selected Podcast
Heart Health at Home
Featured Speaker:
Craig Thomas
Craig Thomas is a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients. Transcription:
Heart Health at Home
Melanie Cole (Host): For patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is a very important goal. My guest is Craig Thomas. He’s a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients. Welcome to the show. Craig, tell us. What are the challenges of living at home for heart failure patients?
Craig Thomas (Guest): Certainly, Melanie. Thank you for having me today. Well, there are many challenges for patients with heart failure living at home. It is a chronic condition, and the nature of that alone means that this is a condition that these patients, most will live with for the remainder of their lives. There was the medical treatment for heart failure patients. There are at least four drug classes that we’d like to have patients on—that is, if they only have heart failure only. Many of our patients will have multiple other comorbidities, other disease processes that have led them to the heart failure, be that a coronary artery disease, uncontrolled hypertension, high blood pressure. All of these things would also, in addition, require other medications and such that would make it more challenging for these patients. But many of the people that I take care of will be on an excess of eight medications, specifically for their heart and their heart disease. That alone means that you have to take multiple medications every day several times a day. That can be challenging.
Also, with heart failure, there are a lot of diet recommendations; things, such as restricting fluids. That’s just one of the major problems with heart failures, the fluid accumulation, and things such as reduced sodium content in your food as well, which is quite difficult in our Americanized diet to avoid those high-sodium foods. And there’s a lot of monitoring. The symptoms of somebody’s heart failure becoming worse for them can be different between different individuals. And so, folks being able to understand what their heart failure symptoms are, being able to recognize those and alert a care provider in an appropriate, timely manner is hugely important to managing heart failure at home.
Melanie: So, Craig, how does the Heart Health at Home Program work to help patients with heart failure? And does it help their families? As you say, it can be a very confusing situation with the medications and the diet, fluid and sodium restriction, adherence to all the protocol that you set out for heart failure patients. How does this program work to help them coordinate all of this?
Dr. Thomas: Certainly. Our Heart Health at Home Program is set up to introduce this program to patients as they are hospitalized for heart failure. We know that when folks are in the hospital with heart failure that that is sort of the worst state of their condition when they need to be hospitalized for that. And so, we know that these people that are there are at very high risk for having relapses in their condition. And so, we contact patients as they are admitted to the University Medical Center and ask them about this program and if they feel like they could benefit from having additional resources at home to help them. Like you’d mentioned, this program helps the patient for sure. And also, note that families are very happy to have some extra eyes in the home and to have a skilled healthcare provider there. Our program works essentially -- I meet and enroll patients while they’re in the hospital. Once they are discharged, a member of my team, they have certified nurse aides that are specifically trained in heart failure and cardiac care. Those are the folks that make our home visit to these patients once they’re discharged.
Our program is set up to see the patient first in their home about 24 to 48 hours after they’ve been discharged from the hospital. And then we make those home visits three to four times the first week at their home, and then maybe two to three times the week following that. And we stage our visits down over time based on the patient’s understanding, the patient and the family’s need for our support. Now, we know with this patient population that hospitalization is an indexed or acute events that mark significant concern for their heart failure, and the further they get out from the hospitalization, the less likely it is that they will have trouble. Now, our program is set up to meet with them frequently and early post-discharge and then taper off as needed.
We’ll follow patients for up to one year in our program, and certainly, if people have additional re-hospitalization, then they’re eligible to restart their services with us. We’ve been in operation going on a year and a half now and have over 100 patients that we’ve enrolled in helping manage their heart failure from home.
Melanie: Craig, are there certain prerequisites for participation in the Heart Health at Home Program?
Dr. Thomas: Sure. We do have some criteria—certainly, being in the hospital as the enrollment location. Our program is set to help people that don’t have any other services to help them. There are other services other than the Heart Health Program that are options for patients at UVA Medical Center—things such as Home Health. So if the patient already has Home Health or is in need of Home Health services, which is different from us, then we would not follow that patient in this Heart Health at Home program. They also must live within 60 miles of the medical center just due to our traveling and schedules and trying to keep my team with patients making an impact rather than on the road so much.
Melanie: Just wondering if the program has improved outcomes for the heart failure patients.
Dr. Thomas: It certainly has. We track the outcomes of our patients. We know that nationally, currently, the re-admission rate for heart failure patients is running around 18 or 19 percent. With the Heart Health at Home program, last year, in the calendar 2013, our re-admission rate was just under 9.5 percent. We are at least a 50 percent reduction in patient care for our program that are returning back to the hospital within that 30 days.
Melanie: Craig, why should patients choose UVA for their heart failure care?
Dr. Thomas: UVA has a very skilled and dynamic advanced heart failure center. We have multiple options for advanced therapies. We have a large skilled team that can work with patients and their families through their chronic care of the heart failure—things such as ventricular assist devices. We are a heart transplant center as well. And then, having these unique programs, such as the Heart Health at Home Program, are hugely beneficial to the patients and their families. I cannot see any other reason why you should not choose UVA for your heart failure care.
Melanie: Give us, please, in the last minute here your best advice for patients living with heart failure and things that they can do to make their lives just a little bit better.
Dr. Thomas: There’s a lot of focus currently in the heart failure care world. Many hospitals like UVA are coming up with different ways to support patients in their home. The challenge, as I mentioned at the beginning, is it may seem simple and seem like something that would be very easy to do. My advice would be to accept any assistance programs that the hospital or medical center may offer. These programs are set up so that we can support you. We know what the needs are of this patient population, and those programs are set up to do that.
Melanie: That’s great information about the UVA Heart Health at Home program. For more information, you can go to uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day.
Heart Health at Home
Melanie Cole (Host): For patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is a very important goal. My guest is Craig Thomas. He’s a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients. Welcome to the show. Craig, tell us. What are the challenges of living at home for heart failure patients?
Craig Thomas (Guest): Certainly, Melanie. Thank you for having me today. Well, there are many challenges for patients with heart failure living at home. It is a chronic condition, and the nature of that alone means that this is a condition that these patients, most will live with for the remainder of their lives. There was the medical treatment for heart failure patients. There are at least four drug classes that we’d like to have patients on—that is, if they only have heart failure only. Many of our patients will have multiple other comorbidities, other disease processes that have led them to the heart failure, be that a coronary artery disease, uncontrolled hypertension, high blood pressure. All of these things would also, in addition, require other medications and such that would make it more challenging for these patients. But many of the people that I take care of will be on an excess of eight medications, specifically for their heart and their heart disease. That alone means that you have to take multiple medications every day several times a day. That can be challenging.
Also, with heart failure, there are a lot of diet recommendations; things, such as restricting fluids. That’s just one of the major problems with heart failures, the fluid accumulation, and things such as reduced sodium content in your food as well, which is quite difficult in our Americanized diet to avoid those high-sodium foods. And there’s a lot of monitoring. The symptoms of somebody’s heart failure becoming worse for them can be different between different individuals. And so, folks being able to understand what their heart failure symptoms are, being able to recognize those and alert a care provider in an appropriate, timely manner is hugely important to managing heart failure at home.
Melanie: So, Craig, how does the Heart Health at Home Program work to help patients with heart failure? And does it help their families? As you say, it can be a very confusing situation with the medications and the diet, fluid and sodium restriction, adherence to all the protocol that you set out for heart failure patients. How does this program work to help them coordinate all of this?
Dr. Thomas: Certainly. Our Heart Health at Home Program is set up to introduce this program to patients as they are hospitalized for heart failure. We know that when folks are in the hospital with heart failure that that is sort of the worst state of their condition when they need to be hospitalized for that. And so, we know that these people that are there are at very high risk for having relapses in their condition. And so, we contact patients as they are admitted to the University Medical Center and ask them about this program and if they feel like they could benefit from having additional resources at home to help them. Like you’d mentioned, this program helps the patient for sure. And also, note that families are very happy to have some extra eyes in the home and to have a skilled healthcare provider there. Our program works essentially -- I meet and enroll patients while they’re in the hospital. Once they are discharged, a member of my team, they have certified nurse aides that are specifically trained in heart failure and cardiac care. Those are the folks that make our home visit to these patients once they’re discharged.
Our program is set up to see the patient first in their home about 24 to 48 hours after they’ve been discharged from the hospital. And then we make those home visits three to four times the first week at their home, and then maybe two to three times the week following that. And we stage our visits down over time based on the patient’s understanding, the patient and the family’s need for our support. Now, we know with this patient population that hospitalization is an indexed or acute events that mark significant concern for their heart failure, and the further they get out from the hospitalization, the less likely it is that they will have trouble. Now, our program is set up to meet with them frequently and early post-discharge and then taper off as needed.
We’ll follow patients for up to one year in our program, and certainly, if people have additional re-hospitalization, then they’re eligible to restart their services with us. We’ve been in operation going on a year and a half now and have over 100 patients that we’ve enrolled in helping manage their heart failure from home.
Melanie: Craig, are there certain prerequisites for participation in the Heart Health at Home Program?
Dr. Thomas: Sure. We do have some criteria—certainly, being in the hospital as the enrollment location. Our program is set to help people that don’t have any other services to help them. There are other services other than the Heart Health Program that are options for patients at UVA Medical Center—things such as Home Health. So if the patient already has Home Health or is in need of Home Health services, which is different from us, then we would not follow that patient in this Heart Health at Home program. They also must live within 60 miles of the medical center just due to our traveling and schedules and trying to keep my team with patients making an impact rather than on the road so much.
Melanie: Just wondering if the program has improved outcomes for the heart failure patients.
Dr. Thomas: It certainly has. We track the outcomes of our patients. We know that nationally, currently, the re-admission rate for heart failure patients is running around 18 or 19 percent. With the Heart Health at Home program, last year, in the calendar 2013, our re-admission rate was just under 9.5 percent. We are at least a 50 percent reduction in patient care for our program that are returning back to the hospital within that 30 days.
Melanie: Craig, why should patients choose UVA for their heart failure care?
Dr. Thomas: UVA has a very skilled and dynamic advanced heart failure center. We have multiple options for advanced therapies. We have a large skilled team that can work with patients and their families through their chronic care of the heart failure—things such as ventricular assist devices. We are a heart transplant center as well. And then, having these unique programs, such as the Heart Health at Home Program, are hugely beneficial to the patients and their families. I cannot see any other reason why you should not choose UVA for your heart failure care.
Melanie: Give us, please, in the last minute here your best advice for patients living with heart failure and things that they can do to make their lives just a little bit better.
Dr. Thomas: There’s a lot of focus currently in the heart failure care world. Many hospitals like UVA are coming up with different ways to support patients in their home. The challenge, as I mentioned at the beginning, is it may seem simple and seem like something that would be very easy to do. My advice would be to accept any assistance programs that the hospital or medical center may offer. These programs are set up so that we can support you. We know what the needs are of this patient population, and those programs are set up to do that.
Melanie: That’s great information about the UVA Heart Health at Home program. For more information, you can go to uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day.