Prophylactic Measures to Decrease Risk of GI Bleeds in Acute Heart Failure Patients May Decrease Readmissions

Introduction Reducing hospital readmission in patients with decompensated heart failure is a national healthcare priority. Following a heart failure admission, up to 25% of patients are readmitted within 30 days. Furthermore, studies suggest that as many as 70% of heart failure readmissions are due to non-heart failure etiologies including fluid and electrolyte disorders, chronic anemia, pulmonary disease, other cardiovascular conditions, and infections. In a review in our hospital, patients requiring readmission for non-heart failure related issues include a prevalence of readmissions for acute gastrointestinal (GI) bleed. There is limited data in regards to GI bleed prevention in this population. Method We identified admitted heart failure patients with an elevated risk of GI bleed and those patients were given a GI prevention strategy which included proton pump inhibitor (PPI) initiation prior to discharge and continuation for 30 days post discharge, routine assessment of Hemoglobin/Hematocrit (H/H) levels pre and post discharge, and regimented follow up with a PCP or GI practitioner. Chart review was performed on all patients readmitted within 30 days of heart failure admission to determine rates of GI bleed causing hospitalization before and after this intervention was initiated. Results Between October 2016 and October 2017, 198 patients were readmitted within 30 days of a heart failure admission. When comparing the six months prior to the initiation of the above-mentioned protocol, to the seven months after initiation, readmissions for GI bleeds decreased from 5 patients to zero patients. Conclusion Identifying heart failure patients at high risk for GI bleeding, with subsequent utilization of PPI therapy and monitoring of labs and follow up, may positively impact the high readmission rate seen in the heart failure population. A large randomized trial should be considered to assess the efficacy of this approach.