Get With the Guidelines in ED Patients With Heart Failure

Summary

Approximately 20-30% of patients presenting with acute heart failure are discharged from the ED. Compared to patients discharged from the hospital, they more frequently return to the ED and hospital for further management. While inpatient discharges are often enrolled in transitions programs and have their care tailored to evidence-based recommendations, ED discharges do not. The investigators propose to evaluate current standard ED discharge to an ED-based intervention which will transition patients to outpatient follow-up on guideline-recommended therapy.

Conditions

• Heart Failure

Interventions

BEHAVIORAL

GUIDED-HF

Participants in this arm will receive a tailored discharge plan via a transition nurse coordinator directed team (TNC Team). 1. Disease education: Health literacy screen will identify barriers to understanding discharge and medication instructions. 2. Lifestyle interventions: Includes receiving smoking cessation information and instructions to track daily weights. 3. Guideline recommendations for medications and device referral: Includes determining the need for prescriptions for ACEIs, ARBs, beta blockers, aldosterone antagonists, anticoagulants and referral for pacemaker/defibrillator consideration. 4. Outpatient follow-up appointment: TNC Team will provide a scheduled appointment within 7 days and will conduct a home visit within 48 hours of ED discharge.

BEHAVIORAL

Standard of Care

Those in the standard care arm will receive structured ED discharge assessment to include: 1. discharge instructions; 2. medication reconciliation 3. encourage follow-up.

Sponsors & Collaborators

• Patient-Centered Outcomes Research Institute

  collaborator OTHER

• Stony Brook University

  collaborator OTHER

• Indiana University

  collaborator OTHER

• Wayne State University

  collaborator OTHER

• VA Office of Research and Development

  collaborator FED

• University of Cincinnati

  collaborator OTHER

• Washington University School of Medicine

  collaborator OTHER

• Baylor College of Medicine

  collaborator OTHER

• MetroHealth Medical Center

  collaborator OTHER

• University of Mississippi Medical Center

  collaborator OTHER

• Emory University

  collaborator OTHER

• University of Iowa

  collaborator OTHER

• Thomas Jefferson University

  collaborator OTHER

• University of Texas

  collaborator OTHER

• Virginia Commonwealth University

  collaborator OTHER

• Vanderbilt University

  lead OTHER

Principal Investigators

• Sean Collins, MD · Vanderbilt University

• Javed Butler, MD · Stony Brook University

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

21 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-10-31

Primary Completion

2019-09-30

Completion

2020-02-29

Countries

• United States

Study Locations