This recognition is the culmination of many hours of hard work from many individuals. Our program is still in the development stages, so it was nice to achieve this. But we still have a lot of work to do.
—Elizabeth Vitanza, Heart Failure and Structural Heart Coordinator at Community Hospital of the Monterey Peninsula
About 6.2 million adults in the United States have heart failure, with the disease contributing to approximately 13 percent of deaths every year, according to the American Heart Association (AHA). Heart failure is the number one reason for hospital admissions in the United States, and just as this disease is a detriment to the health of our communities, its financial impact is equally troublesome with nearly $40 billion in direct and indirect costs yearly.
Since joining the program, Community Hospital’s Heart Failure program was awarded the AHA’S Bronze Award, which is recognition for meeting the required threshold in all AHA heart failure metrics for 90 consecutive days.
“This recognition is the culmination of many hours of hard work from many individuals,” said Elizabeth Vitanza, Heart Failure and Structural Heart Coordinator at Community Hospital of the Monterey Peninsula. “Our program is still in the development stages, so it was nice to achieve this. But we still have a lot of work to do.”
Improvements to care include more comprehensive outpatient follow-up, updated discharge protocols, additional patient education, increased coordination of care, and referrals to heart failure disease management and outpatient cardiac rehabilitation programs.
Community Hospital’s heart failure metrics have shown an impressive performance in a short period of time since joining the AHA’s Get with the Guidelines program, with a sharp decline in readmission rates for heart failure patients.
“One of the most important aspects of a robust heart failure program is the outpatient follow-up,” said Vitanza, who ensures that every heart failure patient has a follow-up visit within seven days after discharge.
A multidisciplinary team of doctors, nurses, social workers, transitional care managers, physical therapists, cardiac rehabilitation, palliative care, and home health agencies provide coordinated care from the patient’s first visit to the last. This broad range of expertise ensures the patient receives personalized and timely care, which has proven beneficial for keeping patients out of the hospital once they are discharged.
“Implementing these new guidelines has helped us consistently identify and treat underlying heart failure causes, manage symptoms, improve quality of life, slow the progression of heart failure, and support patients who have end-stage heart failure.”
The outpatient heart failure clinic is structured so patients are seen as frequently as needed, sometimes as often as once per week, and some appointment spots are reserved for patients experiencing new or worsening symptoms. “We get to know our patients very well and always incorporate their family in the treatment plans. Chronic illness affects not only the patient but their family members as well. We treat our patients like family,” said Kim Godsey, Nurse Practitioner with Montage Medical Group, who manages the clinic.
Vitanza says the goal is to reach Gold-level recognition by 2025, which would be 24 consecutive months of achieving all AHA heart failure performance metrics. The program’s future ambitions also include expanded community education and engagement, support groups, remote patient monitoring, more staff, and innovative procedures like transcatheter mitral valve repair, a minimally invasive structural heart disease treatment where a flexible hollow tube is inserted through a blood vessel to reach the heart and replace the mitral valve without open-heart surgery.
“Our heart failure program stands out because of our heart failure team and their commitment to this community,” Vitanza said. “At the end of the day, we’re improving the health of our community. That is our goal and that’s what counts.”
