Optimizing transition of care pharmacy services by evaluating medication related readmission risk factors within the heart failure population
Background: Heart failure (HF) is the leading cause of hospitalization amongst patients 65 years of age and older and represents a significant clinical and economic burden. Previous studies have sought to identify risk factors associated with readmissions in HF patients. However, no studies have evaluated the medication-related risk factors that present most frequently in readmitted heart failure patients. As the medication experts, pharmacists are in a unique position to intervene and address patients’ medication related risk factors. Multidisciplinary transitions of care models have shown the positive impact on decreased readmissions within high-risk populations like HF when a pharmacist is involved in their care. A retrospective chart review of HF patients within a cardiology unit was conducted to determine medication-related risk factors within the HF patient population that can and should be prioritized for intervention by transitions of care pharmacists. Methods: Patients identified with diagnosis related groups (DRGs) for heart failure admitted to the inpatient cardiology unit of Memorial Hermann Memorial City Medical Center between January 1, 2019 to December 31st 2019 were included in this study. Two groups were evaluated: HF patients readmitted within one year of their initial admission for any reason and HF patients not readmitted within one year of their initial admission. Patients were excluded from the study if they were (1) deceased during their primary admission or (2) were discharged to hospice. Data was retrospectively analyzed based on patient information from the electronic medical record (EMR). Data points analyzed included patient demographics, date of initial admission, date to first readmission and medication-related readmission risk factors (number of medications at initial discharge, number of comorbidities, eGFR during initial admission, and length of stay at initial admission, and presence of high-risk medications at discharge including anticoagulants, antidiabetics, diuretics). Results: A total of 89 patients were included in the final analysis. No statistical significance was noted between the dependent variables and readmission status. However, variables of interest included number of medications at initial discharge and presence of anticoagulants at discharge. Results of a stepwise binomial regression did not reveal that any of the studied medication related risk factors assessed in this study were independently associated with readmission status. Discussion: Due to the lack of statistical significance in medication related readmission risk factors between the two groups, there is insufficient evidence to support that transitions of care pharmacists should prioritize any of the risk factors assessed over others. However, the results of this study does highlight the need for the involvement of comprehensively trained transitions of care pharmacists, who are able to elicit clinic reasoning and judgement in the assessment of medication related readmission risk factors present in patients. Limitations of this study include small sample size, inability to ascertain readmission status for patients readmitted external to our institution and reliance on data entered into the EMR. Conclusion: In the setting of a large community hospital, this study did not identify specific medication-related readmission risk factors in HF patients that should be prioritized over others by transitions of care pharmacists. However, this study did highlight the need for involvement of comprehensively trained transitions of care pharmacists who are able to identify HF patients at increased risk of readmission. These clinicians should place emphasis on addressing inappropriate medication therapy through discharge medication review and anticoagulant counseling while also thoroughly assessing each patient for risk factors that may present on a case-by-case basis.