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Hospital Length of Stay, Patient Reported Outcomes and 30-day Readmission Rates in Heart
Failure Patients Receiving Osteopathic Manipulation.
Otmaskin, E, OMS III; Carroll, B, OMS III; O’Toole, J, OMS IV; Smithson, S, OMS IV; Palermo, N,
D.O.; Welch, R, OMS III; Cloutier, K, OMS III; Dombrowski, J, OMS III; Buan, S, OMS III; Guenette,
C, OMS III; Doyle, R, OMS III.
Manchester Memorial Hospital of Eastern Connecticut Health Network (ECHN) & University of New
England College of Osteopathic Medicine (UNECOM), Department of Medical Education,
Manchester, CT.
Introduction: There are nearly 5 million people living with heart failure in the United States,
accounting for over 1 million hospitalizations per year. There are also 550,000 new cases of HF
diagnosed each year. Heart failure is the most common cause of hospital admissions in the United
States and unsurprisingly, this clinical syndrome is extremely costly and places an increasingly
enormous strain on our healthcare system and can severely lower a patient’s quality of life. Heart
failure as a diagnosis carries a 50% 5 year survival rate. Heart failure is one of the leading causes
for readmission 30 days post-discharge among Medicare Beneficiaries. Along with COPD and
psychosis, HF readmissions accounted for $17.4 billion in 2004. It is in the best interest of hospital
administrators, health care providers, and patients to maximize patient quality of life, minimize
hospital length of stay and readmission for people with this chronic condition. The purpose of this
study is to improve the standard of care for hospitalized heart failure patients. Our hypothesis is that
Osteopathic Manipulation as an adjunct to the standard of care will improve patient outcomes as
measured by Length of Stay, Readmission Rate, and Quality of Life compared to patient outcomes
in those who receive the standard of care only.
Methods: Patients admitted to MMH with a primary diagnosis of HF or HF exacerbation who meet
clinical criteria (both inclusion and exclusion) and provide consent will be randomly placed in 1 of 3
treatment groups: a treatment, a control, or a sham group. All groups will receive standard of care
treatment. In addition to this, one group will receive no additional treatment, one group will receive
an OMM protocol, and one group will receive a sham (placebo) protocol. All participants will
complete a satisfaction survey upon discharge. Patient satisfaction, length of stay, and fluid balance
and weight change will be recorded and compared among the 3 groups. Once sufficient participants
have been recruited, a power analysis will be performed. A two-sample t-test will be used to
examine if there is a significant difference in terms of the length of stay between the study groups.
A two-sample proportion test will be used to examine if there is a significant difference in 30-day
readmission rates among the study groups.
Results: Since IRC approval, the study has 15 patients, and statistical analysis has been done on
13 participants. Following the removal of 4 patients due to prolonged hospital stay and failure to
complete the discharge questionnaire adjusted analysis was completed on 9 patients. The Adjusted
Average Length of Stay: Sham Group 10.75 days (4 patients), Treatment Group 3.5 days (2
patients), and Control Group 6.33 days (3 patients). Average Total Weight Change at End of Stay:
Sham -4.08 kg, Treatment -4.73 kg, Control -4.82 kg. Average Fluid Balance at End of Stay: Sham
-13.5 L, Treatment -3.0 L, Control -4.0 L. Change in average survey score: Sham +11, Treatment
+3.75, Control -1.5. 30 Day Readmissions: Sham 0, Treatment 1, Control 1.
Conclusion: This remains an ongoing research study. It received IRC reapproval in January of
2013. Preliminary data has been analyzed, but remains inconclusive since the sample size has not
met expectations. At the time of this submission, the strongest correlation has been increased
patient satisfaction in the Treatment and Sham groups. Patient recruitment is actively underway,
however the rate of new patient inclusion has fallen short of expectations due to difficulty obtaining
a primary diagnosis of heart failure. Should this study demonstrate improved patient outcomes with
the adjunct of Osteopathic Manipulation, the initiation of larger scale, longer term studies to further
analyze this relationship would be warranted.