Implementation of a Cardiac Transitions of Care Pilot Program: A Prospective Study of Inpatient and Outpatient Clinical Pharmacy Services for Patients With Heart Failure Exacerbation or Acute Myocardial Infarction

Murphy, Julie A.; Schroeder, Michelle N.; Rarus, Rachel; Yakubu, Idris; McKee, Sean O P

doi:10.1177/0897190017743129

Cited by 25 publications

(92 citation statements)

References 17 publications

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“…All studies conducted transitional care interventions for patients with HF. Regarding research design, there were 10 RCTs [16,21,22,24,28,29,32,33,36,38], two quasi-experiments [23,40], two pre-and post-tests [17,26], six cohort studies [18,19,27,34,35,37], and five prospective studies [20,25,30,31,39]. Although it was necessary to establish controls to verify the effects of transitional care interventions, in six of the 25 studies [17][18][19][20]26,39], there was no comparative control group set up to verify the effectiveness of transitional care interventions.…”

Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

“…Regarding research design, there were 10 RCTs [16,21,22,24,28,29,32,33,36,38], two quasi-experiments [23,40], two pre-and post-tests [17,26], six cohort studies [18,19,27,34,35,37], and five prospective studies [20,25,30,31,39]. Although it was necessary to establish controls to verify the effects of transitional care interventions, in six of the 25 studies [17][18][19][20]26,39], there was no comparative control group set up to verify the effectiveness of transitional care interventions. In 15 of the 25 studies, the primary intervention providers were nurses [16,[20][21][22][23][24][25][26][28][29][30]32,33,37,38], including advanced practical nurses, clinical nurse specialists, research ...…”

Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

“…In 15 of the 25 studies, the primary intervention providers were nurses [16,[20][21][22][23][24][25][26][28][29][30]32,33,37,38], including advanced practical nurses, clinical nurse specialists, research nurses, nurse practitioners, cardiac nurses, registered nurses, nurse case managers, registered nurse case managers, and liaison nurses. A multidisciplinary team served as the primary intervention provider in five studies [17,31,35,36,39]. In the remaining five studies [18,19,27,34,40], the major intervention providers were pharmacists or pharmacy students.…”

Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

“…Subjects presented with various HF types: two studies reported on end-stage HF [28,32], three on chronic HF [16,23,33], two on congestive HF [21,37], one on decompensated HF [29], and the remaining 17 on HF [17][18][19][20]22,[24][25][26][27]30,31,[34][35][36][38][39][40]. To identify HF severity, we considered the New York Heart Association (NYHA) class and left ventricle ejection fraction (LVEF).…”

Section: Type and Severity Of Hfmentioning

confidence: 99%

“…One study reported B-type natriuretic peptide level >200 ng/mL [25], and two studies reported HF with reduced or preserved ejection fraction [17,18]. The remaining 12 studies [20,23,26,27,[30][31][32][33]35,[37][38][39] did not report the participants' severity of HF.…”

Section: Type and Severity Of Hfmentioning

confidence: 99%

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Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Son

Lee

et al. 2020

IJERPH

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Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from

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Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

Section: Methodology Of Transitional Care Interventionsmentioning

confidence: 99%

Section: Type and Severity Of Hfmentioning

confidence: 99%

Section: Type and Severity Of Hfmentioning

confidence: 99%

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Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Son

Lee

et al. 2020

IJERPH

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Rationale and design of a navigator‐driven remote optimization of guideline‐directed medical therapy in patients with heart failure with reduced ejection fraction

Blood

Fischer

Fera

et al. 2019

Clinical Cardiology

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Although optimal pharmacological therapy for heart failure with reduced ejection fraction (HFrEF) is carefully scripted by treatment guidelines, many eligible patients are not treated with guideline‐directed medical therapy (GDMT) in clinical practice. We designed a strategy for remote optimization of GDMT on a population scale in patients with HFrEF leveraging nonphysician providers. An electronic health record‐based algorithm was used to identify a cohort of patients with a diagnosis of heart failure (HF) and ejection fraction (EF) ≤ 40% receiving longitudinal follow‐up at our center. Those with end‐stage HF requiring inotropic support, mechanical circulatory support, or transplantation and those enrolled in hospice or palliative care were excluded. Treating providers were approached for consent to adjust medical therapy according to a sequential, stepped titration algorithm modeled on the current American College of Cardiology (ACC)/American Heart Association (AHA) HF Guidelines within a collaborative care agreement. The program was approved by the institutional review board at Brigham and Women's Hospital with a waiver of written informed consent. All patients provided verbal consent to participate. A navigator then facilitated medication adjustments by telephone and conducted longitudinal surveillance of laboratories, blood pressure, and symptoms. Each titration step was reviewed by a pharmacist with supervision as needed from a nurse practitioner and HF cardiologist. Patients were discharged from the program to their primary cardiologist after achievement of an optimal or maximally tolerated regimen. A navigator‐led remote management strategy for optimization of GDMT may represent a scalable population‐level strategy for closing the gap between guidelines and clinical practice in patients with HFrEF.

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Improving transitional care after acute myocardial infarction: A scoping review

Homem,

Reveles,

Amaral

et al. 2024

Health Care Science

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Cardiovascular disease remains the leading cause of morbidity and mortality, posing a significant challenge to healthcare systems worldwide. Transitional care interventions, which ensure coordination and continuity of care as patients move between different levels of healthcare, have been shown to reduce unnecessary healthcare utilization and improve patient outcomes. While much attention has been given to transitional care in heart failure, this review aims to map the interventions implemented for patients following an acute myocardial infarction (AMI). A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with literature searches performed in the Cochrane, CINAHL, MEDLINE, JBI, and SciELO databases, focusing on publications from 2013 onwards in both Portuguese and English. Seventy‐five studies were included, with most combining multiple interventions that contributed to improved cardiovascular health outcomes, including increased adherence to healthy lifestyle behaviors, enhanced medication compliance, and better healthcare self‐management. These interventions were effective in reducing cardiovascular‐related Emergency Department visits, unplanned 30‐day readmissions, and mortality following a first‐time myocardial infarction. Key strategies identified included discharge planning, digital health solutions, outpatient care, and healthcare coordination. The findings of this review underscore the need for developing methodologies that enhance the transition of care from hospital to primary care following an AMI. There is an urgent need to design and implement new healthcare programs that integrate discharge interventions, digital health, outpatient care, and healthcare coordination to ensure continuity of care and optimize patient outcomes post‐discharge.

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Implementation of a Cardiac Transitions of Care Pilot Program: A Prospective Study of Inpatient and Outpatient Clinical Pharmacy Services for Patients With Heart Failure Exacerbation or Acute Myocardial Infarction

Abstract: A "high-touch" pharmacist-driven transitions of care program may affect 30-day readmission rates for patients with HF exacerbation or AMI; potential processes for initiating transitions of care programs are provided.

Cited by 25 publications

References 17 publications

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Rationale and design of a navigator‐driven remote optimization of guideline‐directed medical therapy in patients with heart failure with reduced ejection fraction

Improving transitional care after acute myocardial infarction: A scoping review

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