Study Evaluates Impact of Pharmacist-Led Heart Failure Transition of Care Clinics on Readmission Rates

Referral to a pharmacist-led transition of care clinic does not significantly reduce 30-day readmission rates, according to the results of a study published by Current Problems in Cardiology.

Heart failure plays a significant role in the United States health care system. Patients who are hospitalized for heart failure have a 20% chance of being readmitted to the hospital within 30 days. These high readmission rates account for more than $30 billion annually in medical costs.

Hospitals were challenged to limit readmissions through The Hospital Readmissions Reduction Program in 2012, which reduced payments to hospitals with high 30-day readmission rates. Creating pharmacist-led heart failure transition of care (PharmD HF TOC) clinics was one strategy to come from this challenge.

Previous studies found that PharmD HF TOC clinics significantly reduced hospital readmissions. However, most of these studies ran as-treated analysis and only looked at patients who attended their appointments.

Researchers found fewer than half of patients attend their discharge appointments at PharmD HF TOC clinics. Limiting the number of patients included in the analysis could lead to bias and overestimating the role of PharmD HF TOC clinics in readmission rates.

Researchers analyzed a group of 766 patients who were discharged from a heart failure hospitalization. They ran 2 different analyses—an as-treated analysis of those who attended their appointment and an intention-to-treat analysis of all patients.

When they ran an as-treated analysis, clinic appointments significantly reduced 30-day readmission rates. However, when they ran an intention-to-treat analysis, appointments did not reduce 30-day readmission rates.

If patients attend their discharge appointments at a PharmD HF TOC clinic, they are less likely to be readmitted to the hospital within 30 days for heart failure. However, there are a variety of reasons why patient miss appointments. A patient may not have the financial means to access these services, or might lack the motivation to attend appointments.

The introduction of PharmD HF TOC clinics may not have had as significant an impact on readmission rates as originally reported. More studies using intention-to-treat analyses are needed to evaluate the impact of these clinics.

About the Author

Jessica Dillon is a 2023 PharmD candidate at the University of Connecticut.

Reference

Cheng-Lai A, Prlesi L, Murthy S, Bellin EY, Sinnett MJ, Goriacko P. Evaluating Pharmacist-Led Heart Failure Transitions of Care Clinic: Impact of Analytic Approach on Readmission Rate Endpoints. Curr Probl Cardiol. 2023;48(2):101507. doi:10.1016/j.cpcardiol.2022.101507