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

作者：Zhi-Fen Feng, Yun Liu, Jordan Tovera Salvador, Minerva B. De, M. Nery, Xinyue Huang, Lei Zhang, Shan Liu · 发表于：BMC Nursing · 年份：2025 · DOI：10.1186/s12912-025-03447-5 · 被引用次数：2 · 研究领域：Heart Failure Treatment and Management、Transplantation: Methods and Outcomes、Mechanical Circulatory Support Devices

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 betwe...