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Spotlight: Improving Heart Failure Care

February 2013


Heart failure currently affects nearly five million Americans, and hospital admissions for this condition have increased six-fold in the United States since 1970, due, in part, to an aging population. Moreover, heart failure is the number one reason for discharge for Veterans treated within the VA healthcare system.

VA/HSR&D's Chronic Heart Failure Quality Enhancement Research Initiative (CHF-QUERI) was instrumental in creating the Heart Failure (HF) Provider Network – a network of VA providers interested in improving heart failure care throughout the VA healthcare system. Currently, more than 900 providers from 150 VA Medical Centers and VA healthcare systems participate in this network. The HF Network is an important mechanism for the implementation of interventions that will improve the health and healthcare for Veterans with heart failure, including the VA Hospital-to-Home (VA H2H) initiative.

The H2H Initiative

Co-sponsored by the American College of Cardiology and the Institute for Healthcare Improvement, the national VA H2H initiative is a national quality improvement program designed to reduce preventable readmissions for cardiovascular patients.

H2H focuses on three key areas with the aim of improving the transition to outpatient care:

  • Medication management (e.g. helping Veterans become familiar and competent with their medication);
  • Symptom management (e.g., ensuring that Veterans fully comprehend signs and symptoms that require medical attention); and
  • Early follow-up after discharge (e.g., checking with the Veterans about follow-up visits scheduled within one week of discharge).

Since January 2010, at the request of Robert Jesse M.D., Ph.D., Principal Deputy Under Secretary for Health, CHF-QUERI has facilitated the implementation of the H2H initiative (called VA H2H initiative) through its HF Provider Network. CHF-QUERI has provided toolkits, along with active support such as web-based meetings, e-mails, consultations, and the participation of local opinion leaders. This facilitation has led to the enrollment of 86 (61%) VA hospitals on the national H2H website compared to 28% of all U.S. hospitals. VA hospitals have reported 529 projects related to the VA H2H initiative with the goal of reducing heart failure readmissions: 30% of the participating VA hospitals had ongoing projects, 20% had started a project due to H2H, and 10% had a plan to start a project.

There is evidence that the VA H2H initiative is improving heart failure care for Veterans. For example, Veterans are having more visits with cardiology specialists, and there have been fewer hospitals days over one year. Future work will examine the variation in admission rates and heart failure care practices across facilities to identify successful practices that can be implemented throughout the VA system.

For more information about the HF Provider Network or the VA H2H Initiative, contact: Paul Heidenreich, M.D., M.S., CHF-QUERI Director, at Paul.Heidenreich@va.gov, or Anju Sahay, Ph.D., CHF-QUERI Implementation Research Coordinator, at Anju.Sahay@va.gov .