Advances in Heart Failure Management - Episode 14

Reducing Rehospitalization as an Objective in Heart Failure Management

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The HCPLive Peer Exchange “Advances in Heart Failure Management” features expert opinion and analysis from leading physician specialists on the latest developments in heart failure research, diagnosis, and management.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

  • Michael Felker, MD, MHS, Professor of Medicine, Chief of the Heart Failure Section, Director of the Heart Center Clinical Research Unit, and Director of the Advanced Heart Failure Fellowship at Duke University School of Medicine
  • Jim Januzzi, MD, Roman W. DeSanctis Endowed Distinguished Clinical Scholar in Medicine at Massachusetts General Hospital and Hutter Professor of Medicine at Harvard Medical School
  • Christian Schulze, MD, PhD, Associate Professor of Medicine, Division of Cardiology at Columbia University Medical Center, and Director of Research for the Center of Advanced Cardiac Care at Columbia University Medical Center

This segment of the Peer Exchange delves into the issue of rehospitalization, and why there is so much focus on it as an outcome at the moment, as well as what treatments and strategies are available or being tested to improve it.

Rehospitalization has become a large focus in terms of developing new treatments and also just process of care due to Medicare penalties for excessive rehospitalizations for heart failure, says Felker. While the metric has a negative tone, Felker argues that some rehospitalizations are necessary and are not a bad thing.

Chronic drugs like LCZ696 and ivabradine, says Felker, can potentially “prevent hospitalizations up front,” whereas drugs like serelaxin may have potential in the hospital setting, “although we don’t have the data yet that may impact post-discharge outcomes.” And preventive strategies such as telemedicine are also trying to impact the epidemic.

In addition to medications and prevention tactics, Schulze mentions that new devices are coming to market. He says there is excitement about testing the new drugs in advanced heart failure populations, since “it is still unknown what is the optimum medical treatment in patients on left ventricular assist devices, leading them potentially to a heart transplantation.”