Using population health strategies to reduce readmissions and morbidity in HF

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Do you start patients on different therapies depending on whether they have a reduced ejection fraction or a preserved ejection fraction? What are some of the key differences where you might focus a population health strategy on one patient population and another population health strategy on another?

Rohit Uppal, MD, MBA, SFH: Doctor [John E.] Anderson had fun with this question. Differences from a population health perspective are not significant. When we look at these 2 groups, our goals for them are quite similar. We know that negative morbidity outcomes are similar for both groups, so what can we do to reduce symptoms and improve quality of life? As hospital workers, can we reduce the risk of readmission? The biggest difference is that for patients with preserved ejection fraction, there is no clear evidence that our interventions reduce mortality. But certainly, the objective of reducing morbidity is important. With a reduced ejection fraction, the strategy is clearer. How can we engage our patients in evidence-based, goal-oriented therapy? I have nothing to add in terms of sequencing.

We see patients with preserved ejection fraction with many comorbidities, so we manage the symptoms of their heart failure to make those incremental improvements in their quality of life, and we focus more on common conditions that we see alongside their ICC. [congestive heart failure]: hypertension, atrial fibrillation [atrial fibrillation], coronary artery disease and diabetes. We manage these comorbidities as we would in a non-CHF population, unless there are opportunities where perhaps the second or third line of treatment overlaps with heart failure treatment. Dr. Anderson mentioned SGLT2 [inhibitors] for diabetics, or the mineralocorticoid receptor antagonist for hypertension, which are excellent examples.

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: I appreciate this overview. Dr. Anderson has done a great job giving his opinion on initial treatment, and that’s what helps guide many decisions. In your opinion, you could treat these patients in the same way. As long as we get those results and manage those comorbidities, it will give them their best chance of reducing the progression of heart failure.

Transcript edited for clarity.

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