Rohit Mohindra

Years since first academic appointment: No academic appointment

Title: A prospective randomized pilot trial to reduce readmission for frail elderly patients with acute decompensated heart failure

Author List: Rohit Mohindra, Eli Segal, Xiaoqing Xue, Jonathon Afilalo, Marc Afilalo

Background: Acute decompensated heart failure (ADHF) is a common illness in Canadian emergency departments (ED). The frail subset of elderly patients with ADHF is challenging to treat, use a large proportion of available resources, and are at higher risk for complications, including readmission to hospital after discharge. We believe that by improving access to follow-up, assessing medication adverse effects, and addressing the physiological basis of frailty, it will be possible to improve quality of life and reduce readmission rates for frail patients with ADHF.

Objective: In patients over the age of 70 presenting to the ED with a diagnosis of ADHF and who have a Clinical Frailty Scale (CFS) score of 4-8, can a structured follow-up system and frailty intervention reduce readmissions at 30 days, when compared with patients receiving standard care?

Design: This will be a pilot prospective randomized controlled trial (RCT) at a tertiary academic hospital in Montreal, Quebec. Eligible patients will be ≥ 70 years old with a CFS score of 4-8 who are discharged home with a diagnosis of ADHF. Patients will be randomized 1:1 to either an intervention or control arm. The intervention will consist of contacting the patient 3 days post-discharge and arranging definitive outpatient follow-up, reviewing medication adverse effects, and providing targeted diet and exercise guidance. The control group will receive outpatient follow-up, medication advice and lifestyle guidance as prescribed at discharge from the ED or hospital.

Outcomes: Readmission for any reason by 30 days post-discharge from hospital or ED. Secondary outcomes will include readmission within 90 days of discharge, changes in standardized symptom or CFS scores, and incidence of medication adverse effects.

Expected Results and Impact: After the intervention, frail ADHF patients should have better quality of life, improved symptom control, experience fewer medication side effects, and have less readmissions to hospital. By reducing readmission rates, there will be fewer patients presenting to the ED for care, which will free more resources for hospitals.

Questions for the audience:

  1. How should we deal with patients who are eligible but who present to the ED in the evenings or on weekends?
  2. What is an easy way to flag potentially eligible patients at triage (without creating too much extra work for our busy triage nursing team)?
  3. How could we deal with patients who have follow-up outside our hospital system, to ensure they meet our recommended time to follow-up and adherence to guidelines?