Heart failure is an expanding focus for many health systems, and Jeffrey Farber, MD, president and CEO of The New Jewish Home, has a few ways that hospitals and cardiologists can better care for their older patients.
New York City-based elder-care system is the only skilled nursing system in the state with a Joint Commission-accredited heart failure program. This allows them to not just help patients manage their health, but also get medically complex heart failure patients out of the hospital. The program has expertise in managing older adults with left ventricular assist devices, inotropes and vasopressors.
“Very few nursing homes are equipped to manage these high-acuity needs, and even on general medical floors in hospitals, patients with these needs are typically kept in intensive care,” Dr. Farber, a geriatrician, said in an upcoming episode of Becker’s “Cardiology and Heart Surgery Podcast”.
This puts Dr. Farber in a unique position to bridge care for medical complex patients from hospital to home. Most of his patients stay for less than six weeks and are able to return home to manage their care. Here, Dr. Farber shares four ways cardiology can improve quality of care for their older heart failure patients.
1. Discharge plan early: “The earlier you begin that planning process, the better. That means finding out what is actually available in your local market. I think many cardiologists in New York would still be surprised to learn what [our facility is] capable of and that we can manage patients on LVADs, on inotropes, with IV diuretics. I imagine many would assume those patients have to remain hospitalized until they’re stable enough to go home directly. So getting educated on the resources that exist leads to a much smoother transition.”
2. More warm handoffs to post-acute facilities: “If we could standardize warm handoffs between hospital teams and post-acute providers — including primary care physicians and rehab teams — it would make an enormous difference. I mean an actual conversation between the cardiologist who has been caring for the patient in the hospital and the physician who will be receiving that patient and sharing responsibility in the rehab setting. And as part of that handoff: getting the first follow-up appointment with the specialist already scheduled, with everyone clear on the timing, what to bring and what to watch for. That’s really what will help these patients get well and get home.”
3. Involve medically complex patients in clinical trials: “Trials need clean populations with enough statistical power to detect a result, so patients like ours are naturally excluded. The consequence is that we simply don’t have good data on how to care for medically complex older adults — the very people who are the biggest utilizers of these advancements. Most people living with advanced heart failure who benefit from these interventions are older adults who look exactly like our patients, but they’re not the ones being studied.”
4. Go beyond disease management: “In geriatrics, so much of what we do is about managing competing priorities and quality of life. Recovery is far more involved than stabilizing a cardiac condition. It encompasses mobility, deconditioning, nutrition, cognition, medication management, emotional health, caregiver support, family dynamics and loneliness. Without addressing all of those things, what we tend to see is higher risk for falls and fractures, medication errors, isolation, loss of functional independence and rehospitalization. Good cardiac rehab focuses on helping patients regain not just improvements in disease management, but strength, confidence, function and quality of life.”
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