Sanjeev K. Gulati, MD
Director, Advanced Heart Failure
and Transplant Cardiology
At Carolinas HealthCare System's Sanger Heart & Vascular Institute, we are committed to developing innovative processes that offer patients the very best care. Recent healthcare reform initiatives place a larger emphasis on readmission rates and other quality indicators, and the heart failure community has been directly affected.
Sanger Heart & Vascular Institute has performed more than 488 heart transplants, with an adult one-year survival rate of 96 percent and a pediatric one-year survival rate of 100 percent.
The 30-day readmission rate for heart transplantation at Sanger is 5.88 percent, with the expected readmission rate being 35.13 percent. The average length of stay for patients is 11.11 days, with the expected length of stay being 18.76 days. Both of these parameters are better than expected.
Heart failure affects more than 5 million Americans or approximately 1 in 56 individuals. Of these, only half will survive over the next five years. The population of heart failure patients is expected to double over the next 30 years. Heart failure is the most common cardiovascular discharge diagnosis, medical discharge diagnosis and reason for inpatient readmission. Twenty to 24 percent of heart failure patients are readmitted within 30 days.
Sanger's team of heart failure specialists are at the forefront of the development of a chronic disease management program, designed to streamline guidelines based on heart-failure care and provide patients more efficient, unifying cardiovascular care.
Heart Success is a Carolinas HealthCare System initiative and phased plan developed to standardize and optimize the care of heart failure patients. Following a hospital discharge, the Heart Success program serves as a tool to transition the patient from the acute care setting, which is a high-risk transition point. The program is designed to:
- engage patients and their families to increase adherence to physician direction such as diet and medication
- reduce variations in care
- identify better ways to manage high-risk patients across the care continuum and improve outcomes
- identify and deliver appropriate resources and tools for Carolinas HealthCare System providers to take care of complex patients
- identify and devise solutions for gaps in the continuum of care
In the first five months of operation, more than 175 patients were introduced to the Heart Success program by the inpatient nurse navigator. Without this program, these patients would have been discharged from the hospital without receiving any of the heart failure-specific resources designed to improve patients' quality of life and reduce their chance of readmission.
For patients who choose to enroll in the multidisciplinary team consults with each patient and empowers him or her with resources to self-manage his or her disease and return to the care of their primary care physician or cardiologist. The team includes:
- a dietician
- a pharmacist
- a patient navigator
- a social worker
- a specially trained nurse practitioner and physician assistant
- home-care referrals
- rehabilitation referrals
- telehealth and remote diagnostics/monitoring
The Heart Success program is run by specially trained advanced care practitioners for patients who aren't enrolled in the long-term heart failure clinic, which manages patients with advanced heart failure throughout their disease process. In 2011, patient volume in the heart failure clinic increased 20 percent. Currently, 1,400 patients are being seen in the clinic. Heart transplantation and mechanical circulatory system support are also a part of the advanced heart failure clinic.
Aside from Heart Success, primary care physicians and cardiologists also have the ability to refer patients into the long-term heart failure clinic for continued disease management. The care model is similar to Heart Success and has specialized clinics for pre and post-transplant patients, cardiooncology for patients with cancer and congestive heart failure and pulmonary hypertension.