Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post–hospital discharge period

Abstract

Background People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. Methods This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post–hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. Results Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. Conclusion Numerous challenges continue to affect people living with HF in the post–hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.

Interventions to promote older adult functionality in the hospital-to-home transition: an integrative review

“…Among the interventions used in the studies to promote functionality, highlighted were health information-based trainings and active participation of older adults and caregivers along with a multidisciplinary team in decision-making for self-health management [30][31][32] . Health education was utilized in 89% of the studies [13][14][15][16][17][18]20,21 , aiming at empowering the population with knowledge on health-related topics, thus increasing people's autonomy in their own care 33 .…”

Guideline‐directed medical therapy for heart failure: The key ingredient for successful in‐hospital and post‐discharge care

“…transportation issues, health illiteracy, poor patient activation, financial instability) may contribute to these low numbers. 9 The proportion of early follow-up discharge may be even lower in certain regions of the world, and among patients facing particular challenges related to social determinants of health. Moreover, Figure 1 Guideline-directed medical therapy (GDMT) is the key ingredient for successful in-hospital and post-discharge care among patients with heart failure (HF).…”