Preventing Cardiac Surgery Readmission With Patient Activity Tracking Technology

Patients undergoing cardiac surgery are either discharged home (+/- visiting nurse), to a skilled nursing facility, or to a rehabilitation center.

Readmission rates within 30 days of cardiac surgery are ranging between 8 and 21% in the adult population (1, 2); the largest 10-center study including 5,059 patients reported a readmission rate of 19%, which is in line with the readmission rate for the Department of Cardiac Surgery at the Brigham and Women's Hospital (3). The most common causes for readmissions are volume overload/heart failure, arrhythmia, and infection (3, 4). The Centers of Medicare and Medicaid Services Readmissions Reduction Program initiated revenue penalties for an excess 30-day readmission rate [https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html\]. Home visits of cardiac patients after surgery on postdischarge days 2 and 5 by physician assistants had been shown to decrease readmission rate by 41%, resulting in significant cost savings ($39 saved for every $1 spent) with a readmission cost between $39,100 and $56,600 (5).

Volume overload, congestive heart failure, and infections lead to a decline in activity status. However, when assessing activity levels, self-reported data is often inaccurate and wearable devices greatly improve distinction between physical activity and sedentary time (6, 7). We therefore seek to implement data from wearable devices from patients discharge home after cardiac surgery into the software (recoupERAS) used for our Enhanced Recovery after Cardiac Surgery (ERAS cardiac surgery) program. This would allow us to non-invasively follow the patient's activity level without relying on self-reported data. We would follow the data from the hospital supplied wearable device for 30 days after cardiac surgery. In case of a decline of physical activity which would be seen in recoupERAS, we would proactively contact the patient. This would allow us to make either recommendations over the phone or invite the patient back to the cardiac surgery offices for further assessment before the patient's health status deteriorates to a point where an Emergency Department visit is necessary.

SUBJECT SELECTION All patients undergoing cardiac surgery at the Brigham and Women's Hospital (BWH) who agree to use the RecoupERAS software on their mobile device will be offered a wearable device at no cost to the patient.

a) Inclusion/Exclusion criteria: