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In Reply We appreciate the efforts of Dr Bradley and colleagues to discover means to reduce readmissions after hospitalizations for heart failure. Our Viewpoint attempted to highlight the multiple issues that are related to the lack of progress in this area.
In reference to the study by Bradley et al,1 we had 4 concerns. First, unlike myocardial infarction, for which quality improvement efforts implemented a robust set of acute interventions proven by randomized clinical trials, there are no such known interventions for heart failure hospitalizations and those that are being implemented are generic. Second, data regarding the effectiveness of these generic interventions have been inconsistent across studies. The Institute for Healthcare Improvement’s 5 Million Lives from Harm campaign committed to a 25% reduction in readmission for heart failure from 2006 to 2008 and used many of these interventions; yet despite thousands of hospitals participating, no reductions in readmission for heart failure were observed.2
Butler J, Fonarow GC, Gheorghiade M. Strategies to Reduce Heart Failure Readmissions—Reply. JAMA. 2014;311(11):1160-1161. doi:10.1001/jama.2014.683