Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure

慢性心力衰竭患者从医院到家庭过渡护理干预的实施与评估

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Abstract

BACKGROUND: Chronic Heart Failure (CHF) is a complex clinical syndrome that occurs in the end stages of various cardiovascular diseases. It is characterized by symptoms such as weakness, reduced cardiac function, and decreased exercise capacity. The high incidence, high mortality rate, and poor prognosis of CHF have become prominent features of this disease, making it an urgent and pressing clinical issue. AIM: This study aims to investigate the impact and evaluate the effectiveness of hospital-to-home transitional care for patients with chronic heart failure (CHF). METHODS: Convenient sampling was used to select 60 patients with CHF from the cardiology department of a tertiary Grade A hospital in Guangdong Province between February and June 2022. The patients were divided into a control group and an intervention group using a random number table, with 30 patients in each group. The intervention group received a transitional care intervention mainly focused on the transitional care model (TCM), while the control group received routine treatment and interventions for CHF. RESULTS: The intervention group showed significantly higher levels of self-efficacy and self-management and better cardiac ultrasound examination results than the control group (P < 0.05). The intervention group also had lower scores in laboratory indicators (plasma NT-pro BNP) than the control group (P < 0.05). Hospital readmission rate: There was no significant difference in hospital readmission rates between the two groups (P > 0.05), but the intervention group showed a significant difference in emergency admission rate (P < 0.05). CONCLUSIONS: The hospital-to-home TCM enhances self-management and improves the quality of life for patients with chronic heart failure. The conduct of this research provides clinical practitioners with reference for later research, and is also conducive to the promotion and popularisation of health care policies. This study has registered the ethical review batch number, which is NCT06779227. TRIAL REGISTRATION: The trial has been registered on ClinicalTrial.gov (Ref: NCT06779227). The registration date is January 15, 2025.

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