Researchers tested a simplified transitional care plan for patients leaving the hospital after acute heart failure. The plan included a discharge checklist, heart failure education, and phone check-ins. The study included 982 patients across multiple centers. They compared this plan to usual care over six months.
The main goal was to see if more patients took all three guideline-directed heart failure drugs at six months. The study found no overall difference between the groups. About 50% of patients in the plan group and 45% in the usual care group met this goal. There were also no significant differences in patient-reported symptoms or other clinical outcomes.
However, an analysis of patients who actually received all parts of the plan showed a higher chance of taking all three drugs. The study did not report on safety concerns or side effects.
The main reason to be careful is that the plan's success may depend on how well it is carried out. The findings suggest that simply offering a plan may not be enough; patients need to fully engage with it for a potential benefit.