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Guides Aim to Cut Readmission After Acute Coronary Syndrome

Jim Kling – Apr 16, 2013

As part of its Initiative on Acute Coronary Syndrome, the American College of Physicians (ACP) has developed a guide for patients, a practice guide for physicians, and 2 videos aimed at improving health outcomes after an initial event.

The release of these materials was announced during a news conference at ACP Internal Medicine 2013 in San Francisco, California.

In the United States, an estimated 5 million patients are at risk for acute coronary syndrome, and approximately 134,000 die from it every year. Acute coronary syndrome results in almost 1.2 million hospitalizations each year — 70% for heart attack and 30% for unstable angina.

Patients are at particularly high risk for hospital readmission in the first year after an event. Readmission rates “hover around 20%,” Doron Schneider, MD, chief safety and quality officer of Abington Health System in Pennsylvania and member of the initiative’s National Steering Committee, said at the news conference.

Four focus groups, comprised of patients who had experienced an acute coronary syndrome in the previous year, were asked to identify the barriers and issues they experienced. Their input was used to develop the materials.

The physician practice guide was developed to ensure that physicians are as prepared as possible for the patient’s postdischarge office visit. It provides assessment suggestions and encourages physicians to collect all patient materials, including discharge summaries and the results of hospital tests, so that they will be available during the visit.

The patient guide has sections on leaving the hospital, arriving home, and preparing for the postdischarge office visit. The workbook-like 20-page patient-centric guide covers lifestyle issues, concerns about medication, and more. It also addresses the reasons patients don’t take their medication — a common problem in acute coronary syndrome. The goal of the guide is “to empower patients to discuss medication issues with their physician,” Dr. Schneider explained.

Two videos designed to empower patients to actively engage in their care — entitled “Discharge From the Hospital” and “Medications After a Heart Attack” — will be available soon.

A driving force behind the initiative is to reduce the 20% readmission rate, which contributes greatly to healthcare costs. “There is increasing emphasis on the need to avoid hospital readmission. Patients with acute coronary syndrome are at a very high risk for readmission if they don’t understand their disease or how to manage their medication, or if they don’t have appropriate communication with and access to their physician,” ACP executive vice president and chief executive officer Steven Weinberger, MD, said at the news conference.

The ACP already has a guide for patients with acute coronary syndrome, called “Caring for Your Heart,” but it focuses on lifestyle choices and doesn’t address the transition from the hospital to home. “This builds a bridge to that content,” said Dr. Schneider, “so that the patient who’s just had an event can carefully navigate that end of hospitalization to land safely at home.”

The ACP Initiative on Acute Coronary Syndrome was funded by a grant from Janssen Pharmaceuticals. Dr. Schneider and Dr. Weinberger had no relevant financial relationships to disclose.

ACP Internal Medicine 2013. Presented April 12, 2013.