Teaching to Reduce Readmissions After a Heart Attack

Essential patient education to address the most common complications

Introduction

Around 12% of heart attack survivors are readmitted to the hospital within 30 days of discharge.[1] The reason may be another heart attack, but that isn’t usually the case. Around half of these readmissions are not even cardiac-related.[1]

Heart attack readmissions cost an estimated $718 million and lead to 281,000 additional hospital bed days per year.1 Researchers estimate that 1 in 4 general readmissions are preventable,[2] but the preventability of post-heart attack readmissions is likely higher.

In one study, researchers used a smartphone app with a smartwatch and wireless blood pressure cuff to reduce post-heart attack readmissions by 52%.[3] They addressed many preventable root causes with medication reminders, vital-sign tracking, education, and appointment reminders.

Providing every patient with the various technologies used in this study may be impractical, but care teams can address the same root causes in low-tech ways.

Focused education at the bedside can make a big difference. Nurses can teach patients about exercise, vital-sign monitoring, warning symptoms, disease management, and organizing medications. Patient Guide Solutions’ accessible patient education booklets are easier to use than a stack of papers and easier for patients to reference later if they forget something.

Why patients get readmitted after a heart attack

Some of the most common reasons patients are readmitted to the hospital after surviving a heart attack include: [1],[4]

●      Heart failure

●      Acute coronary syndrome

●      Ischemic heart disease

●      Another heart attack

●      Chest pain --- both cardiac and noncardiac

●      Infections

●      Procedural complications

●      Complications of other medical conditions

Use comprehensive teaching to lower the rates of these complications.

What to teach after a heart attack

Not every readmission is preventable, but patients play a considerable role through self-management. To make daily choices that enhance their health, they need to understand what to do and why it matters. Your education should cover the following topics for the best chance of successful disease management.

Infection prevention

Overall, 8.8% of readmissions post-heart attack are due to infections.[1] Decreased blood flow after a heart attack makes patients more susceptible to infections. Urinary tract infections, intestinal infections with Clostridium difficile, and skin infections each lead to 1% of readmissions.[4]

Patients can help prevent infections by washing their hands, getting appropriate vaccinations, avoiding people who are sick, hydrating, eating a healthy diet, and using antibiotics responsibly.

Medication management

Medication errors lead to a fifth of all readmissions.[5] To help patients avoid medication errors, make sure they understand:

●      What they need to take

●      Why it is important

●      Critical side effects

●      How much to take

●      How and when to take it

●      How to organize medications

●      Systems to avoid missed doses

Control cardiac risk factors

Half of readmissions after a heart attack are cardiac-related.[1] Protecting the healing heart from cardiac risk factors is critical. Help patients understand how to control blood pressure, understand blood pressure medications, eat a healthy diet, and get safe exercise. Direct them to cardiac rehab programs to get buy-in and help them know what to expect.

Prevent blood clots

A blood clot in the coronary arteries can cause another heart attack —- leading to up to 10% of readmissions.[4] Blood clots wreak havoc in more areas than the heart too. Pulmonary embolisms account for 1% of post-heart attack readmissions.[4]

Teach patients how to prevent blood clots and manage blood thinner medications. Include instructions on frequent mobilization, compression stockings, and the signs and symptoms of blood clots.

Medical conditions that increase readmission risk

Some medical conditions increase the risk of readmission after a heart attack.[1],[4] These include diabetes, heart failure, kidney failure, chronic lung disease, and cardiac arrhythmias. Teach patients additional considerations for post-heart attack disease management, including:

• Diabetes. A body under stress is much more likely to have unstable blood sugar. Help patients avoid hypoglycemia or diabetic ketoacidosis by explaining to them how diabetes symptoms can change when they are sick and recovering.

• Heart failure. Damage from a heart attack can make heart failure worse. Patients should pay extra attention to fluid balance to avoid overload as their heart heals.

• Kidney failure. Patients with kidney failure should monitor their fluid balance and follow dietary guidelines — especially regarding potassium. High potassium levels can build up in patients with kidney failure and cause cardiac arrest. Patients on dialysis should go to every treatment to avoid dangerous fluid and electrolyte imbalances as they heal.

• Chronic lung disease/COPD. People with COPD have a higher risk of heart attacks and a higher risk of death after a heart attack.[6] Heart attacks can look different in people with COPD. Teach your patients that symptoms of another heart attack may include shortness of breath or atypical chest pain.[7]

• Cardiac arrhythmias. Stress on the heart can make arrhythmias worse. Teach patients how to reduce cardiac risk factors like high blood pressure, high cholesterol, and excess weight.

Conclusion:

This heart month, help your post-heart attack warriors avoid becoming a readmission statistic. Check your patient education for critical gaps. Patient Guide Solutions’ education was created by nurses to cover what patients need to know to manage their health and stay out of the hospital.

References:

[1] Kwok CS, Capers Q 4th, Savage M, et al. Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014. Coron Artery Dis. 2020;31(4):354-364. doi:10.1097/MCA.0000000000000844

[2] Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176(4):484. doi:10.1001/jamainternmed.2015.7863

[3] Marvel FA, Spaulding EM, Lee MA, et al. Digital health intervention in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2021;14(7). doi:10.1161/circoutcomes.121.007741

[4] Wang H, Zhao T, Wei X, Lu H, Lin X. The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol. 2019;42(10):889-898. doi:10.1002/clc.23238

[5] El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA, Karapinar-Çarkit F. Prevalence and preventability of drug-related hospital readmissions: A systematic review. J Am Geriatr Soc. 2018;66(3):602-608. doi:10.1111/jgs.15244

[6] Quint J. The relationship between COPD and cardiovascular disease. Tanaffos. 2017;16(Suppl 1):S16-S17.

[7] Goedemans L, Bax JJ, Delgado V. COPD and acute myocardial infarction. Eur Respir Rev. 2020;29(156):190139. doi:10.1183/16000617.0139-2019