Evidence-based strategies for heart failure transitions include adequate decongestion, pre-discharge initiation of disease-modifying therapies, cardiac rehabilitation, and transitional care.
This review synthesizes evidence on optimizing the hospital-to-home transition for patients with worsening heart failure through decongestion, early pharmacotherapy initiation, and transitional care.
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Heart failure (HF) is a leading cause of hospitalization in older adults. Patients are at high risk of readmission and death following hospitalization for HF. There is no standard approach of health care delivery during the hospital-to-home transition period, leaving missed opportunities in care optimization. In this review, we discuss contemporary randomized clinical trials that tested decongestion strategies, disease-modifying therapies, and health care services that inform the care of patients with worsening HF. We provide evidence-informed recommendations for optimizing therapies and improving outcomes during and following hospitalization for HF. These include adequate decongestion with loop diuretics and select sequential nephron blockade strategies based on early evaluation of diuretic response; initiation of disease-modifying pharmacotherapies prior to hospital discharge with close follow-up and optimization after discharge; cardiac rehabilitation; and transitional or palliative care referral post-hospitalization. Evidence-based implementation strategies to facilitate broad uptake include digital health tools and algorithm-driven optimization of pharmacotherapies.
Oskouie et al. (Wed,) reported a other. Evidence-based strategies for heart failure transitions include adequate decongestion, pre-discharge initiation of disease-modifying therapies, cardiac rehabilitation, and transitional care.