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Circ Heart Fail. 2017 Feb;10(2). pii: e003581. doi: 10.1161/CIRCHEARTFAILURE.116.003581.

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 (Get With the Guidelines in Emergency Department Patients With Heart Failure).

Author information

  • 1From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.).
  • 2From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.). sean.collins@vanderbilt.edu.

Abstract

GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure) is a multicenter 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 patients with HF. 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 postdischarge care and avoid subsequent ED revisits and inpatient admissions. Up to 700 patients at 11 sites will be enrolled over 3 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.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519283.

KEYWORDS:

disease management; heart failure; transitional care; vulnerable populations

PMID:
28188268
PMCID:
PMC5319725
[Available on 2018-02-01]
DOI:
10.1161/CIRCHEARTFAILURE.116.003581
[PubMed - in process]
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