The Heart Failure Readmission Intervention by Variable Early Follow-up (THRIVE) Study: A Pragmatic Randomized Trial.

Area of Science:

• Cardiology
• Health Services Research
• Nursing

Background:

• In-person clinic follow-up within 7 days of hospital discharge for heart failure (HF) is linked to reduced 30-day readmissions.
• Challenges exist in completing early post-discharge clinic visits due to healthcare system and patient factors, exacerbated by the pandemic.
• Alternative follow-up strategies are needed to maintain care quality and reduce readmission rates.

Purpose of the Study:

• To evaluate the impact of structured, non-physician telephone follow-up versus physician-led in-person clinic visits on 30-day readmission and death rates in heart failure patients.
• To compare the frequency and type of follow-up care completed within 7 days post-discharge between the two intervention groups.

Main Methods:

• A pragmatic randomized trial was conducted involving adults discharged home after HF hospitalization.
• Participants were randomized to either an initial telephone visit (nurse/pharmacist-led with structured protocol) or an initial in-person primary care physician clinic visit.
• Outcomes measured included 30-day readmissions (HF and all-cause), all-cause death, and completion of 7-day follow-up.

Main Results:

• No significant differences were observed in 30-day heart failure readmission (8.6% vs. 10.6%), all-cause readmission (18.8% vs. 20.6%), or all-cause death (4.0% vs. 4.6%) between telephone and clinic groups.
• Completed 7-day follow-up was significantly higher in the telephone group (92%) compared to the clinic group (79%).
• The frequency of clinic visits within the first 7 days post-discharge was lower in the telephone group (48%) versus the clinic group (77%).

Conclusions:

• Early, structured telephone follow-up effectively increases 7-day follow-up rates for heart failure patients post-discharge.
• This strategy achieves comparable 30-day clinical outcomes to traditional in-person visits while reducing the need for in-person appointments.
• Telephone-guided follow-up offers a viable alternative within integrated care delivery frameworks, improving patient access and potentially reducing healthcare system strain.