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Reducing Heart Failure Readmissions Through an Advanced Practice Nurse-Led Clinic With Navigator Support
1Heart Failure Clinic, Ascension Illinois, Heart & Vascular, Elk Grove Village, Illinois, USA.
Background:
Acute heart failure is a leading cause of hospital readmissions, with nearly 20% rehospitalized within 30 days. Our institution's rate was over 27%, exceeding the national average.
Project Rationale:
To reduce readmissions, we launched an Advanced Practice Nurse-led clinic supported by Heart Failure Navigators. The strategy focused on lifestyle education, proactive monitoring, and coordinated care.
Project Summary:
Between 2021 and 2024, we followed up with adult patients discharged with New York Heart NYHA functional class II to IV heart failure, implementing telemonitoring, lifestyle coaching, guideline-directed medical therapy, and proactive outreach by Heart Failure Navigators.
Take-Home Messages:
Advanced practice nurses, with navigator support, reduce readmissions, boost medication adherence, and improve quality of life and outcomes.
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