TY - JOUR
T1 - Reducing rates of readmission and development of an outpatient management plan in pulmonary hypertension
T2 - lessons from congestive heart failure management
AU - Dolan, Justin
AU - Mandras, Stacy
AU - Mehta, Jinesh P.
AU - Navas, Viviana
AU - Tarver, James
AU - Chakinala, Murali
AU - Rahaghi, Franck
N1 - Funding Information:
JD, JPM, VN, and SM have nothing to disclose. JT reports personal fees from United Therapeutics, personal fees and nonfinancial support from Medtronic, Inc., and personal fees and nonfinancial support from United Therapeutics, outside the submitted work. MC reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from United Therapeutics, grants and personal fees from Reata, grants from Eiger, grants from Novartis, grants from Liquidia, grants from Complexa, grants and personal fees from Phase Bio, grants and personal fees from Arena, grants from Medtronic, personal fees from Gilead, personal fees from Express Scripts, and personal fees from Akros, outside the submitted work. FR is a researcher, consultant, and speaker for Actelion, Bayer, and United Therapeutics. He is also a researcher and consultant for Acceleron. He reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from United Therapeutics, and grants and personal fees from Acceleron, outside the submitted work.
Funding Information:
JD, JPM, VN, and SM have nothing to disclose. JT reports personal fees from United Therapeutics, personal fees and nonfinancial support from Medtronic, Inc., and personal fees and nonfinancial support from United Therapeutics, outside the submitted work. MC reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from United Therapeutics, grants and personal fees from Reata, grants from Eiger, grants from Novartis, grants from Liquidia, grants from Complexa, grants and personal fees from Phase Bio, grants and personal fees from Arena, grants from Medtronic, personal fees from Gilead, personal fees from Express Scripts, and personal fees from Akros, outside the submitted work. FR is a researcher, consultant, and speaker for Actelion, Bayer, and United Therapeutics. He is also a researcher and consultant for Acceleron. He reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from United Therapeutics, and grants and personal fees from Acceleron, outside the submitted work. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© The Author(s) 2020.
PY - 2020
Y1 - 2020
N2 - Pulmonary hypertension currently has minimal guidelines for outpatient disease management. Congestive heart failure studies, however, have shown effectiveness of disease management plans in reducing all-cause mortality and all-cause and congestive heart failure-related hospital readmissions. Heart failure exacerbation is a common reason for readmission in both pulmonary hypertension and congestive heart failure. Our aim was to review individual studies and comprehensive meta-analyses to identify effective congestive heart failure interventions that can be used to develop similar disease management plans for pulmonary hypertension. A comprehensive literature review from 1993 to 2019 included original articles, systematic reviews, and meta-analyses. We reviewed topics of outpatient congestive heart failure interventions to decrease congestive heart failure mortality and readmission and patient management strategies in congestive heart failure. The most studied interventions included case management, multidisciplinary intervention, structured telephone strategy, and tele-monitoring. Case management showed decreased all-cause mortality at 12 months, all-cause readmission at 12 months, and congestive heart failure readmission at 6 and 12 months. Multidisciplinary intervention resulted in decreased all-cause readmission and congestive heart failure readmission. There was some discrepancy on effectiveness of tele-monitoring programs in individual studies; however, meta-analyses suggest tele-monitoring provided reduced all-cause mortality and risk of congestive heart failure hospitalization. Structured telephone strategy had similar results to tele-monitoring including decreased risk of congestive heart failure hospitalization, without effect on mortality. Extrapolating from congestive heart failure data, it seems strategies to improve the health of pulmonary hypertension patients and development of comprehensive care programs should include structured telephone strategy and/or tele-monitoring, case management strategies, and multidisciplinary interventions.
AB - Pulmonary hypertension currently has minimal guidelines for outpatient disease management. Congestive heart failure studies, however, have shown effectiveness of disease management plans in reducing all-cause mortality and all-cause and congestive heart failure-related hospital readmissions. Heart failure exacerbation is a common reason for readmission in both pulmonary hypertension and congestive heart failure. Our aim was to review individual studies and comprehensive meta-analyses to identify effective congestive heart failure interventions that can be used to develop similar disease management plans for pulmonary hypertension. A comprehensive literature review from 1993 to 2019 included original articles, systematic reviews, and meta-analyses. We reviewed topics of outpatient congestive heart failure interventions to decrease congestive heart failure mortality and readmission and patient management strategies in congestive heart failure. The most studied interventions included case management, multidisciplinary intervention, structured telephone strategy, and tele-monitoring. Case management showed decreased all-cause mortality at 12 months, all-cause readmission at 12 months, and congestive heart failure readmission at 6 and 12 months. Multidisciplinary intervention resulted in decreased all-cause readmission and congestive heart failure readmission. There was some discrepancy on effectiveness of tele-monitoring programs in individual studies; however, meta-analyses suggest tele-monitoring provided reduced all-cause mortality and risk of congestive heart failure hospitalization. Structured telephone strategy had similar results to tele-monitoring including decreased risk of congestive heart failure hospitalization, without effect on mortality. Extrapolating from congestive heart failure data, it seems strategies to improve the health of pulmonary hypertension patients and development of comprehensive care programs should include structured telephone strategy and/or tele-monitoring, case management strategies, and multidisciplinary interventions.
KW - pulmonary arterial hypertension
KW - pulmonary circulation
KW - pulmonary heart disease
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85097277714&partnerID=8YFLogxK
U2 - 10.1177/2045894020968471
DO - 10.1177/2045894020968471
M3 - Article
C2 - 33343880
AN - SCOPUS:85097277714
SN - 2045-8932
VL - 10
JO - Pulmonary Circulation
JF - Pulmonary Circulation
IS - 4
ER -