Hillegass: PT Cardiopulmonary Educators: web-based continuing education program partners Cardiopulmonary Specialists: a consulting company CEO Speaker for Genentech: a pharmaceutical company Receives Royalties: Essentials of Cardiopulmonary Physical Therapy and Rehab Notes Crouch: -PT Cardiopulmonary Educators (Partners) -Cardiopulmonary Therapy Research (CEO) Miller: Financial— Kenneth Miller receives compensation from MedBridge for the production of this course. There are no other relevant financial relationships. Nonfinancial— No relevant nonfinancial relationship exists.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
Rebecca Crouch, PT, DPT, MS, CCS, FAACVPR
Dr. Rebecca Crouch has practiced cardiovascular and pulmonary physical therapy in the acute care and outpatient rehabilitation settings, and was a founding member and director of the Duke University pulmonary rehabilitation outpatient program for 30 years. She is now an assistant professor in the Doctor of Physical Therapy program at Campbell University, and her clinical…Read full bio
Ellen Hillegass, PT, EdD, CCS, FAPTA
Dr. Ellen Hillegass is a physical therapist with APTA board certification in cardiovascular and pulmonary clinical specialty. She currently holds the position of adjunct professor in the departments of physical therapy at Mercer University in Atlanta and Western Carolina University in Cullowhee, NC. Ellen is also the president and CEO of Cardiopulmonary Specialists, a private…Read full bio
Kenneth L. Miller, PT, DPT, GCS, CEEAA
Dr. Kenneth Miller has been an educator, physical therapist, and consultant for the home health industry for more than 20 years and serves as a guest lecturer, adjunct teaching assistant, and adjunct professor in the DPT program at Touro College in Bay Shore, New York. He has presented at the Combined Sections Meeting of the…Read full bio
1. Overview of Hospital Readmissions in Heart Failure
Heart failure readmissions are a major concern for the U.S. health system. Medicare has now instituted penalties for readmissions within 30 days of hospital discharge. Possible reasons for heart failure readmissions are explored.
2. Heart Failure: The Diagnosis, Staging of HF, Prognosis, Diagnostic Tests, Symptoms, Medications, and Treatment
Heart failure is defined including systolic versus diastolic (or HFpEF vs. HFrEF) and staging using the New York Heart Classification versus American College of Cardiology is discussed. Various diagnostic procedures including lab values, ejection fraction, and other diagnostics are discussed as well as an overview of treatment options for heart failure.
3. Heart Failure Predictors of Readmission and Poor Outcomes
Certain risk factors are predictors of higher event rates and worsening clinical outcomes which would make patients at risk for readmission. These are discussed, as well as the actual pathophysiology that brings patients back to the hospital. In addition to risk factors, frailty is discussed as a measure of risk for readmission including methods for measurement of frailty.
4. Treatment of Decompensated HF in the Acute Care Setting
Starting with a case study, HF decompensation will be presented including the clinical presentation, medical management, pharmacologic treatment, monitoring, and additional interventions that may be considered. The role of physical therapy and the assessment of frailty is presented followed by a discussion of discharge recommendations for the HF patient.
5. What About After the Acute Care Admission? What is the Transition/Information Exchange to Home Care or Outpatient?
The first week following hospital discharge to home are the most vulnerable time points where readmission is most likely to occur. Effective information exchange between upstream hospital provider and downstream home care providers is critical to reducing vulnerabilities and errors during transitions. Impaired physical functioning, hospital length of stay, medical complexity, comorbidities, and social support are critical areas to address prior to and after the discharge to insure a smooth transition home.
6. Home Care Programs for the Patient With Heart Failure: Best Practices Utilizing ICF Model
The home is the most unstructured practice setting requiring patient engagement and activation in self-management. Patient adherence to medication regime, diet, and physical activity are keys to improving outcomes such as quality of life and patient safety. Patient education and communication resources for patient self-monitoring of decompensation reduce rehospitalization rates and are explored here.