Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial

Abstract

OBJECTIVES: To examine the effectiveness of a transi- tional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure. DESIGN: Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge. SETTING: Six Philadelphia academic and community hospitals. PARTICIPANTS: Two hundred thirty-nine eligible pa- tients were aged 65 and older and hospitalized with heart failure. INTERVENTION: A 3-month APN-directed discharge planning and home follow-up protocol. MEASUREMENTS: Time to first rehospitalization or death, number of rehospitalizations, quality of life, functional status, costs, and satisfaction with care. RESULTS: Mean age of patients (control n 5121; inter- vention n 5118) enrolled was 76; 43% were male, and 36% were African American. Time to first readmission or death was longer in intervention patients (log rank w2 55.0, P 5.026; Cox regression incidence density ratio 51.65, 95% confidence interval 51.13-2.40). At 52 weeks, inter- vention group patients had fewer readmissions (104 vs 162, P 5.047) and lower mean total costs ($7,636 vs $12,481, P 5.002). For intervention patients, only short-term improvements were demonstrated in overall quality of life (12 weeks, Po.05), physical dimension of quality of life (2 weeks, Po.01; 12 weeks, Po.05) and patient satisfaction (assessed at 2 and 6 weeks, Po.001). CONCLUSION: A comprehensive transitional care inter- vention for elders hospitalized with heart failure increased the length of time between hospital discharge and read- mission or death, reduced total number of rehospitaliza- tions, and decreased healthcare costs, thus demonstrating great promise for improving clinical and economic out- comes. J Am Geriatr Soc 52:675-684, 2004.