Design and Rationale of a Randomized Trial of a Care Transition Strategy in Patients with Acute Heart Failure Discharged from the Emergency Department: GUIDED-HF

摘要

GUIDED-HF is a multi-center randomized trial of a patient-centered transitional care intervention in patients with acute heart failure (AHF) who are discharged either directly from the Emergency Department (ED) or after a brief period of ED-based observation. To optimize care and reduce ED and hospital revisits there has been significant emphasis on improving transitions at the time of hospital discharge for HF patients. Such efforts have been almost exclusively directed at hospitalized patients; individuals with AHF who are discharged from the ED or ED-based observation are not included in these transitional care initiatives. Patients with AHF discharged directly from the ED or after a brief period of ED-based observation are randomly assigned to our transition GUIDED-HF strategy or standard ED discharge. Patients in the GUIDED arm receive a tailored discharge plan via the study team, based on their identified barriers to outpatient management and associated guideline-based interventions. This plan includes: conducting a home visit soon after ED discharge combined with close outpatient follow-up and subsequent coaching calls to improve post-discharge care and avoid subsequent ED revisits and inpatient admissions. Up to 700 patients at 11 sites will be enrolled over three years of the study. GUIDED-HF will test a novel approach to AHF management strategy that includes tailored transitional care for patients discharged from the ED or ED-based observation. If successful, this program may significantly alter the current paradigm of AHF patient care.