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Essential Elements of Early Post Discharge Care of Patients with Heart Failure

  • Management of Heart Failure (T. Meyer, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis.

Recent Findings

Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge.

Summary

The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.

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Abbreviations

ACE-I:

Angiotensin-converting enzyme inhibitors

ARNI:

Angiotensin receptor-neprilysin inhibitor

CMS:

Centers for Medicare and Medicaid Services

CRT:

Cardiac resynchronization therapy

GDMT:

Guideline-directed medical therapy

HCS:

Health care system

HF:

Heart failure

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricular ejection fraction

LOS:

Length of stay

PDV:

Post discharge visit

SGLT-2:

Sodium-glucose cotransporter-2 inhibitors

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Funding

This manuscript was funded internally by the Yale University Section of Cardiovascular Medicine, New Haven, CT.

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Authors and Affiliations

  1. Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA

    Richard J. Soucier, P. Elliott Miller, Nihar R. Desai & Tariq Ahmad

  2. Division of Cardiology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06032, USA

    Joseph J. Ingrassia

  3. Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT, USA

    Nihar R. Desai

  4. Division of Pharmacy, Yale University School of Medicine, New Haven, CT, USA

    Ralph Riello

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  1. Richard J. Soucier
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  5. Nihar R. Desai
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  6. Tariq Ahmad
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Corresponding author

Correspondence to Tariq Ahmad.

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Conflict of Interest

Richard J. Soucier, P. Elliott Miller, Joseph J. Ingrassia, Ralph Riello, and Nihar R. Desai declare that they have no conflict of interest.

Tariq Ahmad reports personal fees as a consultant for Amgen and Cytokinetics, received a grant from HFSA/St Jude Medical, is and was a speaker for Novartis during the conduct of the study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Management of Heart Failure

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Soucier, R.J., Miller, P.E., Ingrassia, J.J. et al. Essential Elements of Early Post Discharge Care of Patients with Heart Failure. Curr Heart Fail Rep 15, 181–190 (2018). https://doi.org/10.1007/s11897-018-0393-9

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