• Vishwaratn Asthana, Miel Sundararajan, Ruth Linda Ackah, Vivek Karun, Arunima Misra, Allison Pritchett, Pallavi Bugga, Angela Siler-Fisher, and William Frank Peacock.
• Baylor College of Medicine, United States. Electronic address: asthana@bcm.edu.
• Am J Emerg Med. 2018 Dec 1; 36 (12): 2166-2171.

BackgroundHeart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients.MethodsHF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group. Eligible patients provided informed consent, had an established HF diagnosis, and were hemodynamically stable. Intervention patients received a standardized educational intervention in the ED waiting room before seeing the emergency physician, and a 30-day telephone follow-up. Primary and secondary endpoints were 30- and 90-day ED and hospital readmission rates, as well as days alive and out of hospital (DAOH) respectively.ResultsOf the 94 patients enrolled, median age was 58.4 years; 40.4% were female, and 54.3% were African American. Intervention patients (n = 45) experienced a 47.8% and 45.3% decrease in ED revisits (P = 0.02 &P < 0.001), and 60.0% and 47.4% decrease in hospital readmissions (P = 0.049 &P = 0.007) in the 30 and 90 days pre- versus post-intervention respectively. Control patients (n = 49) had no change in hospital readmissions or 30-day ED revisits, but experienced a 36.6% increase in 90-day ED revisits (P = 0.03). Intervention patients also saw a 59.2% improvement in DAOH versus control patients (P = 0.03).ConclusionAn ED educational intervention markedly decreases ED and hospital readmissions in un- and under-insured HF patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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