Predischarge and Postdischarge Heart Failure Management: Treatment Optimisation, Adherence, and Multidisciplinary Care

Hospitalisation for heart failure presents a critical event associated with significant risk of readmission and mortality. It also offers a window of opportunity to optimise patient management with a goal to improve clinical outcomes, functional status, and quality of life. This narrative review summarises contemporary, evidence-based strategies for optimising heart failure management before and after hospital discharge. Firstly, comprehensive assessment of congestion status is necessary before discharge because residual congestion is a major contributor to poor outcomes. In addition, robust evidence supports the early initiation and rapid up-titration of core guideline-directed medical therapies in all patients without known contraindications, irrespective of left ventricular ejection fraction. The core guideline-directed medical therapies classes include renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. Intensive strategy to optimisation of renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists has been shown to reduce the risk of death or readmission by 34% at six months compared to standard care. Likewise, initiating sodium-glucose cotransporter-2 inhibitors during hospitalisation has demonstrated favourable effects on clinical outcomes, including lower risk of all-cause mortality and readmission. Furthermore, multidisciplinary care and early and sustained postdischarge follow-up are essential to address comorbidities, ensure continuity of care and allow further optimisation of medical therapy. They also enable timely management of potential issues concerning drug intolerance, side effects, nonadherence, or changes in clinical status. Successful long-term management and adherence to treatment recommendations also requires structured patient education and empowerment for self-care.