Transitional care program for heart failure

Background: Heart failure affects nearly six million people in the United States, with approximately one million being admitted into the hospital each year. Despite the use of guidelines and advances in therapy, patients diagnosed with heart failure continue to have the highest readmission rates of any hospitalized patients. Numerous studies have documented the benefits of heart failure education and follow-up care to decrease heart failure readmissions, but consistent results are not well documented.;Purpose: The purpose of this research was to determine the effect a transitional care nurse providing education, coordination of care and outpatient support would have on the 30 day heart failure readmission rate and patients' perceived quality of life.;Method: This quasi-experimental study analyzed the relationship between interventions provided (education, referrals, appointment scheduling, homecare, and follow-up phone calls) to determine the effect on heart failure patients' readmission rates and the effect on patients' perceived quality of life. A convenience sample was obtained from patients admitted to the hospital with heart failure from mid-January 2015 until mid-April 2015. During this study, 375 patients were identified to have a diagnosis of heart failure, and 33 patients meeting the inclusion criteria were enrolled in to the study. All patients received individualized heart failure education, were offered interventions, and were followed for a 30 day period post index hospitalization. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was given to patients to assess quality of life.;Conclusion: No significant correlations were identified between interventions and 30 day heart failure readmissions, but there were significant correlations noted between chronic obstructive pulmonary disease (COPD) and 30 day all-cause readmission rates of heart failure patients. A correlation also existed between those patients taking digoxin and 30 day all-cause readmission rates. Although this study did not demonstrate a significant correlation between a transitional care program and heart failure 30 day readmissions, it did indicate a significant improvement in patients' perceived quality of life.