Soucier Richard J, Miller P Elliott, Ingrassia Joseph J, Riello Ralph, Desai Nihar R, Ahmad Tariq
Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.
Division of Cardiology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06032, USA.
Curr Heart Fail Rep. 2018 Jun;15(3):181-190. doi: 10.1007/s11897-018-0393-9.
Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis.
Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.
心力衰竭给美国患者和医疗保健系统都带来了巨大负担。多项国家政策举措致力于提高心力衰竭护理质量，包括减少住院后的再入院情况，这种情况常见、成本高昂且至少部分是可预防的。从住院护理向门诊护理环境的过渡以及出院后的 immediately 时期为进一步优化符合指南的药物治疗、识别与心力衰竭恶化相关的可逆问题以及评估预后提供了机会。它还可以提供药物核对与优化、考虑基于设备的治疗、适当管理合并症、识别个体护理障碍以及基于预后讨论护理目标的机会。
近期研究表明，关注患者合并症的细节、护理障碍、利尿剂和神经激素治疗的优化以及预后评估可改善患者预后。尽管过渡期似乎是全面解决这些问题的最佳时机，但大多数患者出院后并未被转介至专门采用这种方法的项目。本综述的目的是提供一份出院后早期护理大纲，使临床医生和其他医疗保健提供者能够以既严格遵循指南又以患者为中心的方式护理这些心力衰竭患者。关于哪种干预措施最有可能使该疾病的哪类患者亚组受益的数据尚缺，值得进一步研究。
