Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition

Med Care. 2002 Apr;40(4):271-82. doi: 10.1097/00005650-200204000-00003.


Background: The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses.

Methods: A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge.

Results: At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03).

Conclusions: There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aftercare / standards*
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Chi-Square Distribution
  • Continuity of Patient Care / standards*
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Heart Failure / nursing*
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Patient Discharge / standards*
  • Patient Education as Topic
  • Patient Readmission
  • Prospective Studies
  • Quality of Life*
  • Self Care
  • Sickness Impact Profile
  • Surveys and Questionnaires