Home-based care for heart failure: Cleveland Clinic’s “Heart Care at Home” transitional care program

With length of hospital stay for heart failure patients steadily decreasing, the home has become an increasingly important venue of care. Contemporary research suggests that postacute, home-based care of patients with chronic heart failure may yield outcomes similar to those of clinic-based outpatient care. However, the transition to home-based care is associated with a number of risks. Indeed, these patients often experience a downward cycle of repeat hospitalization and worsening functional capacity. In 2010, a group at Cleveland Clinic launched the "Heart Care at Home" program in order to minimize the risks that patients experience both when being transitioned to home and when being cared for at home. This program joins a handful of transitional care programs that have been discussed in the medical literature.