Keeping Heart Failure Patients Out of the Hospital
Shudhanshu Alishetti, MD discusses his session on how to reduce hospital readmissions in patients with heart failure. He emphasizes the serious toll heart failure takes on both patient outcomes and healthcare costs, particularly among Medicare patients, and explains that each readmission significantly worsens prognosis. In his talk, he outlines past and present strategies—including guideline-directed therapy and implantable pulmonary artery pressure sensors—while also addressing limitations in care delivery and infrastructure. Drawing on his team’s experience at NewYork-Presbyterian, Dr Alishetti looks ahead to new technologies, such as wearable and passive monitoring devices, and envisions how artificial intelligence could optimize patient management and support broader adoption of proactive, seamless care approaches.
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Shudhanshu Alishetti, MD: My name is Shudhanshu Alishetti. I'm one of the heart failure cardiologists at Weill CorneLl and Brooklyn Methodists as part of the New York Presbyterian System. I'm going to be talking about strategies to keep patients out of the hospital with heart failure. So the idea is, try to get people out of the hospital, but then keep them out. We'll talk about their reasons for that and what strategies we have available now and what potential things are in the pipeline.
C360: What are the key themes of your presentation?
Dr Alishetti: We'll start by talking about what the burden of heart failure is to society and especially hospitalization rates and what that means in both financial terms as well as health terms. In particular we know that the readmissions for heart failure have implications in terms of how what the mortality is in these patients as well as morbidity and so that just kind of paints a picture of why we feel that it's important to try to keep people out of the hospital.
Then we'll talk about what strategies have been tried in the past to keep people out of the hospital, what has worked, what hasn't worked, where we are today, what sort of newer technologies we have that we use.
We'll talk a little bit about our own experience here in New York Presbyterian. And then we'll end with some kind of other upcoming technologies that may be useful in the future, especially thinking about things like wearable devices that are becoming so ubiquitous these days.
C360: Why is this topic particularly relevant right now?
Dr Alishetti: Heart failure has a very high burden in the US. The number of patients affected with heart failure keeps going up. By 2030, we expect there to be eight million people with heart failure. And so, you know, it's one of the most expensive things that we deal with in the healthcare system. In fact, if you look at patients being discharged from hospitals, it's one of the most, it is actually the highest most frequent discharge diagnosis for Medicare patients. So this kind of gives you a sense of how much heart failure affects people in the US.
And so with that in mind, we find this to be a very important topic and the health of our patients. And again, the costs of readmissions, both from a financial standpoint as well as from the mortality standpoint is high. So we really want to find ways to try to control that. With each readmission the patients have, their mortality significantly increases. When someone is first diagnosed with heart failure and they are admitted to the hospital, the average, about 50 % of people survive to two years.
So that means half the people will be dead before 2 years. When you start adding on readmissions there, when you get to the fourth readmission, that changes to 50% mortality in 6 months. So it really is a marker of sick patients, and we really want to, you know, we use it as a surrogate to try to say, "Hey, if these readmissions make people sicker, "if we can limit the amount of readmissions they have, "can they be more stable and do better long term?"
C360: What are the most important takeaways for clinicians in practice?
Dr Alishetti: I think the most important is that there's a gap. We have medical therapy that we use that works very well. We do okay, but we could do better in the way we treat people with the medical therapy, the quote unquote guideline directed medical therapy.
We know it works very well when it's implemented well. But even beyond that there's other tools that we have to try to keep people out of the hospital and for the reasons I mentioned earlier. I want them to know kind of what's been tried, what has been used elsewhere, and what the limitations those other technologies are.
What we have currently with the limitations of that technology is some of the implantable devices like the PA sensors, the pulmonary artery pressure sensors that we use more frequently now. But even simpler things like weight management, how well does that work, what's the data behind that, those sorts of things. I want that to be the takeaway. And then, of course, just always thinking about what's coming up in the future.
C360: What gaps in knowledge or areas for future research still remain?
Dr Alishetti: Awareness is important, you know, I think a lot of providers, when they take care of heart failure patients, we treat heart failure as a chronic disorder like hypertension or diabetes and sort of put people on the certain amount of medication and then sort of string them along on those medications and just hope that they do okay.
But you know, as I kind of pointed out earlier, that from the time of admission, mortality for heart failure is pretty high, 50% of people surviving to 2 years. So it's kind of on the same level as stage three lung cancer. And of course, you know, we treat lung cancer very seriously, and, you know, regressive with chemotherapy with surgeries. So I think we should look at heart failure the same way that we should be treating these patients as aggressively as you treat people with malignancies.
And the point is to kind of point out that there's tools to do that, to try to really maximize what we're doing for our patients that work, that it's important to use them when we can. I will talk about the difficulties. There are definitely challenges involved in implementing some of these tools, some of them mean staffing and, you know, if you're going to do remote monitoring of patients, how are you going to do it? Who is going to be the ones that review the data that comes through? You know, not everybody's going to have that infrastructure built in. So that definitely is a major limitation. So what are some potential strategies around that?
But there's definitely a gap. And I think, you know, there's, While the tools we have are good right now, there's still room for improvement. We have now a new PA sensor in the market that we can start using that includes the use of a blood pressure cuff and a scale so that might be better.
But I think there's still room to see how can we use wearable devices? How can we— patients are not, it's not easy to convince every patient to undergo an implantation of something. So are there good technologies we can use that are wearable that you don't have to do a procedure to implant them?
Are there technologies we can use that take away any sort of burden from the patients where they have to actively do something, because many of the remote monitoring devices and strategies that we have, patients have to actually do something. Like for example, they have to weigh themselves every day or they have to lay on a pillow to make, to measure the pulmonary artery pressures every day. You know, that puts a burden on the patients and they may forget, they may get busy and not have time to do it. So there's something we can do that's a lot more seamless where we don't have to put them through that.
I think those are all things that we can continue to improve and of course just looking at what technology comes out—and then, you know, today with how exciting the world of AI is and how it's getting put more and more into the medical world, I think it'll be really interesting to see how we can tie AI into managing patients medically, using some of these devices that we have available to us, can we build really great algorithms to really optimize their care. So I think there's plenty of room for us to continue to improve this. There's plenty of room for the device companies out there to continue to work on improving their designs, coming up with new designs, and then implementing more interesting software.